We are turning our kids into pill poppers. The rate of ADHD has tripled in just 20 years -- it is now diagnosed in 11 percent of all children aged 4-17 and is medicated in 6 percent of them. And the percentages get really crazy for teenage boys -- 20 percent are diagnosed and 10 percent are medicated.
There is also compelling evidence that most of this "ADHD" comes from careless diagnosis. How else to explain that a child's date of birth is the best predictor of whether he gets the label -- the youngest kid in the class is almost twice as likely as the oldest to be diagnosed with ADHD. Misplaced diagnostic exuberance has turned age-appropriate immaturity into a psychiatric disease and treats it with a pill, rather than just letting the kid grow up.
The drug companies are delighted. Their annual revenue from ADHD drugs has exploded -- it is now 50 times greater than 20 years ago, up to almost $10 billion a year. Wouldn't most of this money be better spent not on pills but rather to reduce class sizes and provide more gym periods so that fidgety kids could blow off steam?
It gets worse. Prescribed stimulants are now a favorite drug of abuse in colleges and high schools. Visits to emergency rooms because of overdoses have quadrupled in the last few years as ADHD pills provide easy access to legal speed.
And it gets scary ridiculous -- 10,000 toddlers under age 3 are receiving ADHD drugs. How can this possibly make any sense?
The kiddie pill pushing is not restricted to ADHD. Having saturated the adult market for antidepressants, the drug companies began recruiting kids. Children are ideal long-term customers because they start early and may stay on pills for life. An amazing 4 percent of teenagers are already on antidepressants despite the fact that these meds are less effective and more risky in this age group.
Antipsychotics round out the marketing nightmare. They are prescribed loosely and without clear indication for all sorts of childhood behavioral problems -- even though they can turn kids into zombies, promote massive obesity, and raise the risk of diabetes and heart disease. Some kids are taking a whole cocktail combination of different pills with additive side effects and risks.
The drug companies successfully penetrated and then saturated the kiddie market by employing aggressive marketing to doctors and a massive direct advertising campaign to consumers (note that this shameful practice is permitted only in the US and New Zealand). They have sold the misleading message that psychiatric problems were under diagnosed in kids, easy to diagnose, caused by a chemical imbalance, and easily treated with a pill.
The marketing was mostly aimed at primary care doctors who now do the bulk of prescribing of psychiatric medicines. They usually write quick and unnecessary script after a very brief visit, seeing the child on his worst day. Kids change a lot from month to month without intervention and are the toughest patients to diagnose. Medication should be a last resort used only for the clearest, most impairing, and most persistent disorders. Instead the meds are often prescribed carelessly -- almost like candy.
The pill pushing, disease mongering, fear inducing advertising has been aimed at parents, teachers, and the kids. It is everywhere on TV, the Internet, and print and usually ends with "Ask your doctor!'' If you do, he is primed by drug salesmen to write a script or give you a free sample.
This is great for profits, terrible for kids. The long-term benefits of inappropriately prescribed meds are questionable, the long-term risks real. We are in effect doing an uncontrolled experiment bathing immature brains with powerful chemicals -- without knowing what will be their ultimate impact.
Because parents are the best protection against this glut of kiddie medicating, I have asked Dave Traxson to offer his advice. Dave is a practicing Educational Psychologist, a member of the Division of Educational Psychology Committee of the British Psychological Society, and a tireless campaigner against the over-prescription of psychotropic drugs for school aged children. Here are his tips for parents to safeguard their children from excessive diagnosis and medication treatment:
1.) If the ADHD behavior is not severe and does not occur in all settings, then medication may well be inappropriate. Try 'watchful waiting' instead -- i.e. see if improvements occur naturally or with changes in environment, exercise, expectations, diet, schedules, routines, and parenting. Counseling and relaxation training can really help and should be tried before medication.
2.)Increasing physical activity can help fidgety kids. Enroll them in a team sport, swimming, yoga, martial arts, dance or tumbling -- anything to let the kid blow off steam and acquire discipline.
3.) Realize that there is a wide range of normal when it comes to activity and focus. Not every difference is a sign of disease.
4.) Kids also differ in the pace of their development. Immaturity is not a disease.
5.) Many drug advisory bodies around the world say avoid medication if your child is under the age of five.
6.) Children on psychotropic pills for longer than two years should have a 'drug holiday' to see if they still need them.
7.) If you are worried about the cumulative toxicity from a 'drug cocktail' ask the advice of both your pharmacist and your physician. The more opinions the better.
8.) If you or your child's school have noticed adverse side effects, consult your physician and also inform yourself by Internet search (e.g. enter 'Factsheet -- Ritalin side effects'). The factsheet gets you started and also provides good additional references.
9.) If your child has high levels of anxiety, psycho-stimulants can raise agitation levels.
10.) Do you regularly worry about the wisdom of your action to co-operate with your child's medication for behavioral issues -- then a good 'rule of thumb' is to discuss the situation with a range of people whose opinion you trust and then reflect on the courses of action available.
11.) When your school is pressing for your child to be medicated, first, don't be railroaded. They are worried most about quieting the class; you need to worry most about the welfare of your child.
12.) When you make a well informed decision to withdraw your child from a medication due to concerns about side effects etc. always do it under medical supervision and based on information provided by reliable sources. Medicine should always be started carefully, but should also always be withdrawn carefully.
Thanks for the great advice, Dave.
Parents need to know that psychiatric drugs are being way over-prescribed for kids and that common sense changes in life style and parenting are much better than a headlong rush to pills. There is, for example, no evidence that pills improve long term academic achievement and every reason to fear long term complications.
This is not to say pills are never needed. They can be helpful, sometimes essential, for clear cut and severe cases when all else has failed -- as a last resort, not a careless panacea.
Nelson Mandela said: "There can be no keener revelation of a society's soul than the way in which it treats its children."
We should be treating our kids with fewer drug company pushed pills and with more love, understanding, and exercise.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.