U.S. Kids Might Not Be Over-Medicated After All
MONDAY, Dec. 3 -- A large new study challenges the notion that too many U.S. teens with attention-deficit/hyperactivity disorder (ADHD) and other mental health conditions are prescribed psychiatric drugs, when in fact only 14 percent of such adolescents receive them.
Concerns that drugs like Ritalin have been inappropriately prescribed to children and adolescents are based on anecdotal evidence or the results of studies that didn't use clinical information but instead only reviewed prescription databases, the researchers explained.
"We did not find overuse of medications and there did not appear to be misuse of medications among those who had a mental disorder during the last year," said study author Kathleen Merikangas, senior investigator and chief of the genetic epidemiology branch at the U.S. National Institute of Mental Health.
"There are more kids out there who have chronic disorders who are not on medications than who are on medications," Merikangas noted.
Of these children, about half are getting mental health treatment, she said. Many children with mental disorders, however, go undiagnosed and untreated. In some cases, parents don't want their child evaluated. In other cases, parents don't want their children on medications, she said.
Merikangas advised parents of children with these problems to see a mental health professional who can decide how best to treat the problem. However, a limited number of mental health professionals exist to meet the needs of all the children with mental disorders, she said, with waiting lists to see a psychiatrist taking six to 15 months. In addition, many schools aren't equipped to deal with these issues, she said.
The report was published in the Dec. 3 online edition of the Archives of Pediatrics & Adolescent Medicine.
Researchers collected data on more than 10,000 teens, aged 13 to 18, who took part in a nationally representative survey between February 2001 and January 2004, and who had mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Overall, 14.2 percent of teens who had a mental disorder had been treated with drugs. About 20 percent had been diagnosed with ADHD.
Others had diagnoses of mood disorders, eating disorders, behavior disorders, substance use or anxiety disorders. Medication use was highest among those with ADHD (31 percent), followed by those with mood disorders (19.7 percent), eating disorders (19.3 percent), behavior disorders (19.3 percent), substance use disorders (14.4 percent) and anxiety disorders (11.6 percent), according to the study.
Antidepressants were most often prescribed for mood disorders, while stimulants such as Ritalin were most often prescribed for ADHD.
Antipsychotic drugs were prescribed infrequently and mostly for teens with serious developmental disorders, the survey found.
Most children taking these drugs are, however, are not getting any psychotherapy, which could help them manage their disorder, said study co-author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center, in New York City.
"This suggests that more needs to be done to increase access and availability of this alternative treatment," Olfson said. "Parent management training, cognitive problem-solving skills training and other therapies are examples of promising but underused treatments for young people with disruptive behavioral problems."
Although drugs can deliver rapid improvement in children with severe conduct problems and aggressive behaviors, it is not clear whether they are helpful for the larger group of children with ADHD, Olfson said.
"There are also uncertainties over the long-term effects of these medications on social, cognitive and physical development of children," he said. "For these reasons, there is an urgent need to develop safe, effective and readily available alternatives to help children and adolescents with clinical aggression."
Dr. David Rubin, who wrote an accompanying journal editorial, said that "rather than arguing about who is right -- those who think children are overusing medication, versus those who think this issue is overstated -- the conflicting data really tells a story of very different experiences for children in this country depending on where they're from and the resources their family has."
Many families with typical health insurance simply cannot afford mental health care for their children, he said.
"At the same time, for our most high-risk children in the Medicaid program, who may be provided services for free, those services are highly skewed to medication treatments that may carry significant safety concerns," said Rubin, co-director of the PolicyLab at the Children's Hospital of Philadelphia and an associate professor of pediatrics at University of Pennsylvania School of Medicine.
"It should bother us that many children do not have access to the appropriate services they need, and that rates of medication use -- whether high or low -- are really a symptom of mental health system that does not meet the standard of what any parent -- whether rich or poor -- would hope for their children if they were in crisis," Rubin said.
To learn more ADHD, visit the U.S. National Institute of Mental Health.
Posted: December 2012
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