Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Friday, February 19, 2010

Drugs or No Drugs: Comments on Judith Warner's New York Magazine Article: Are Too Many Kids Medicated?

PART ONE

No parent wants to see their child suffer. It goes against human nature. Thus I found the implication of the last sentence of Judith Warner’s recent New York magazine piece Are Too Many Kids Medicated quite alarming.

Try preaching the noble beauty of honest suffering to a suicidally depressed 6-year-old. It’s probably fair to say he or she would choose happiness over authenticity any day.
She seems to be saying that our choice as parents is to let our children suffer or give them medication. It made me wonder, as one reader commented, whether she is under the influence of the pharmaceutical industry.

There is a third option. Being understood by a person you love is one of the most powerful feelings there is. The need for understanding is what makes us human. When our feelings are validated, we know that we are not alone. For a young child, this understanding facilitates the development of his mind and his sense of himself. Research at the interface of neuroscience and developmental psychology demonstrates that when a parent can “hold a child in mind’ without being overwhelmed by his or her own distress, he or she may influence a child’s development at the level of gene expression and biochemistry of the brain.

Being fully emotionally present with your child in this way is a very difficult task. Parents and other family members may themselves have suffered from similar problems, increasing their desperation to find a quick easy fix for their child’s troubles. Marriages are strained when children struggle, and parents then may not be able to rely on each other.

Under certain circumstances, when children are incapacitated by symptoms, medication may be indicated. But the choice is not between prescribing a pill or letting them suffer. As a society, we must support parents in their efforts to be fully emotionally present with their children. Parents are the ones who can best help their own children.

PART TWO

When addressing the question of overmedication of children, it is important to make a distinction between ADHD and the newer diagnoses such as pediatric depression and bipolar disorder.

ADHD is a diagnosis that has been around for well over 50 years. We understand a great deal about the neurobiology of the disorder. Stimulants, the medications used most commonly to treat the disorder, have a good safety profile. They have clearly been demonstrated to improve attention and organization. When kids struggle in school, self esteem suffers. These medications have been shown to improve academic performance(though studies of long term benefits are less optimistic) The major problem is our over-reliance on medication to treat complex problems. I address this issue in a previous blog post.

Pediatric depression and bipolar disorder are much less well understood, and the side effects of medications used to treat them are much more serious. As a pediatrician with over 20 years experience, I have no doubt that there are children who from a very young age, are chronically unhappy. In addition many families struggle with children who have explosive, irritable behavior. But there are other ways to understand and help these children that do not necessarily involve prescribing a pill. It is essential that we keep our minds open to alternative ways of thinking about these children other than that offered by the powerful pharmaceutical industry.
Please see my two pieces in the Boston Globe, Mind Altering Drugs and the Problem Child and A Dangerous Label For Children for further discussion of this issue.

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