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When is it appropriate to put a very young child on drugs for serious psychiatric disorders? More doctors are prescribing antipsychotics for extremely young children and infants, even though their impact on young brains is still unclear. We’ll discuss how these drugs are being used and how they should be regulated.
- Duff Wilson Reporter, The New York Times
- Dr. Ben Vitiello Chief of Child and Adolescent Treatment and Preventive Research, National Institute of Mental Health
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Here's a scenario no parent imagines before it happens to you. Your child has violent meltdowns, incidents that go way past the realm of normal tantrums. Your babysitter declares that she's almost ready to quit. You're at your wits end and feel your kid is essentially out of control. What do you do?
MR. KOJO NNAMDIA growing number of parents are turning to antipsychotic drugs to help children with conditions ranging from autism to attention deficit disorder. These drugs are being prescribed for younger and younger children, including some who have yet to reach their first birthdays. Some physicians say they're alarmed by the trend and there's still no consensus about how these drugs affect growing brains or how young is too young to be diagnosed with a serious psychiatric disorder.
MR. KOJO NNAMDIJoining us in the studio to discuss children and antipsychotic drugs is Dr. Ben Vitiello. He is chief of the Child and Adolescent Treatment and Preventive Interventions Research branch at the National Institute of Mental Health. Dr. Vitiello, thank you for joining us.
DR. BEN VITIELLOThank you for inviting me.
NNAMDIJoining us from the studios of NPR in New York City is Duff Wilson. He's a reporter for The New York Times. Duff Wilson, thank you for joining us.
MR. DUFF WILSONMy pleasure. Thanks.
NNAMDIDuff, you wrote recently about the story of a child named Kyle Warren. Tell us about Kyle's behavior and the treatments he started to receive as a toddler.
WILSONKyle's a Louisiana boy and he had language problems as a one-year-old and he had temper problems and he had family home-life problems. And he was throwing these huge fits, hitting his head sometimes, screaming and throwing things, totally out of control. When his mother took him to see a pediatrician, he diagnosed Kyle with autism right away, because of the language problems probably, and prescribed this powerful antipsychotic drug to control him.
WILSONIt turns out, almost six years later now, that he was probably not autistic or psychotic. Kyle is now six years old in first grade. He's quite normal, a happy little boy so...
NNAMDIWhat changed about his treatment?
WILSONWhat changed was after being on antipsychotic drugs for a couple of years, he was weaned off them and he and his family were getting a lot more counseling, parent-child interactive therapy, you know, help with the family stresses and for the mother and child to communicate better. And all this worked a lot better than the drug in Kyle's case.
NNAMDIKyle's story seems pretty exceptional, but it's my understanding that the number of children taking antipsychotic drugs is going up, right, Duff?
WILSONYes, it is. There's no precise number of them, but at least half a million under the age of 18 in the U.S. and some tens of thousands under the age of six.
NNAMDI800-433-8850 is our number if you're interested in joining the conversation. Has your child struggled with mental health issues at a very young age? What kinds of treatment options did you pursue? 800-433-8850 or you can simply go to our website and join the conversation there. The website is kojoshow.org. Ben Vitiello, is there any consensus in the medical community in terms of how young is too young to prescribe antipsychotic medications for?
VITIELLOWell, antipsychotic medications are currently approved by the Food and Drug Administration for the treatment of adults, of course, with schizophrenia and with bipolar disorder and also for children starting at age five for the control of very severe behavioral problems connected with autism or of a pervasive developmental condition. So no studies (word?) have looked at this medication under age five, as far as I know.
NNAMDIAre you aware, Ben -- I mean, Duff, what's known about how these drugs affect the brains of very young children?
WILSONOh, that's a lot better question for Ben, as the doctor, really...
NNAMDIYeah, but he just indicated there have been no studies done for children so far.
WILSONWell, yeah, that's the problem. There's no studies for kids that small. It would be unethical to do them so really the science supporting the use of them, these drugs in toddlers, is nonexistent.
NNAMDIOh, I'm sorry. Go ahead, Duff Wilson.
WILSONYeah, so you have parents and doctors out there kind of grasping their way around of how to apply the science for older ages into these younger kids.
NNAMDIBen Vitiello, what's the appropriate way to diagnose whether a young child has a serious mental condition?
VITIELLOWell, at the moment, unfortunately, in psychiatry, we don't have any lab tests we call biological markers. We don't have any markers that objectively can tell us if there is schizophrenia, if the kid has bipolar disorder, depression or even autism. So it is a clinical diagnosis by putting together the information. And we know, for instance, that you can probably make a diagnosis of schizophrenia starting at age nine, ten, occasionally even at a younger age, if the picture is very clear.
VITIELLOThe same we can probably say for bipolar disorder. But at a very young age, all that you can do is to see if the development seems to be normal or abnormal. You can make a diagnosis about these early on. However, even at two years of age, you can suspect autism. Even 18 months of age. But in terms of bipolar disorder, personally in 25 years of practicing child psychiatry, I haven't really ever seen a bipolar disorder in preschool age. So I think there is no agreement on the validity of this construct in such a young age.
NNAMDIIs there a relationship between bipolar and depression and anxiety? It used to be that we didn't think children as young as toddlers could experience depression or anxiety. Now, it seems that some in the medical community are starting to believe that those things can be seen in very young children. What are your thoughts on that?
VITIELLOWell, certainly anxiety is an emotion that exists in young children. It's a reaction to stress and so it is a non-specific reaction to a situation that is unpleasant or perceived to be threatening. In terms of depression, there is some discussion actually between age three and five, one can actually diagnose kids with depression. There is discussion, but there is no consensus at this point. It is still research. About age five, age six, most people agree that you can make a diagnosis of major depression in children.
NNAMDIOn to John in Kensington, Md. John, you're on the air. Go ahead, please.
JOHNHi, good afternoon. I'm both a clinical physician and I am a high school educator in special ed. And my two comments are, first, there seems to be a great degree of variability in diagnoses so that, in my opinion, a lot of these kids are put on medications without necessarily really clear cut reasons for doing so. And my second comment that I see, both as a physician as well as an educator, is that there's really poor tracking in the educational setting of what impact these medications are having on the kid's behavior and the kid's academic performance. And so to the guests, the two questions really are, are there better ways to diagnose these kids consistently and two, are there better ways to track the benefits or the detriments that these medications are having?
VITIELLOCertainly, there are better ways. The reality, I think, is that clinicians tend to treat symptoms and not really disorders so the diagnosis, unfortunately, is not really the focus of their attention. They tend to react to a situation of crisis when the child is out of control, when there are a lot of tantrums, where there is aggression that cannot be controlled by the family. The family feels impotent and so the temptation of having a quick prescription to try to fix a problem as soon as possible is very high. And if it does work, then it tends to stick. And unfortunately, the whole issue is never revisited in a very systematic way considering the development of the child over time. So I think this happens quite a bit.
NNAMDIGo ahead, please, Duff Wilson.
WILSONI'd just like to add to that that the latest research from Columbia University that showed a doubling in the use of antipsychotic drugs by two to five-year-olds who are privately insured over about a six-year period, the same research showed that only 40 percent of these two to five-year-olds on the drugs had received a proper mental health assessment at all. So there's really a lack of in-depth assessments, I think, on a lot of these small kids.
NNAMDIAnd you mentioned another aspect of this that, I guess, is important, Duff Wilson. Does family income play into this? because you mentioned private insurance. Kyle's family, as you mentioned in your piece, is low income. How does that affect a family's options?
WILSONWell, in a lot of ways, not in good ways, usually. Often both parents or the single parent has to work so it's a lot harder to get into counseling and it's -- they rely on daycare centers or schools to take care of their kids. So if the daycare or the school says, we're going to kick your kid out because he's out of control, then the parents more often may have to rely on the medication.
WILSONAlso, there was a study last year that showed kids on Medicaid from low-income families were four times as likely as the privately insured to be prescribed antipsychotic medicines.
NNAMDIIndeed. In your piece, you write that it's cheaper to medicate children than to pay for family counseling. Are there any safeguards that could be put in place, Dr. Vitiello, to ensure that families aren't pushed to put their kids on these drugs that they may not need? And then, you can chime in, too, Duff Wilson. But first, you, Ben.
VITIELLOYeah, there are attempts, actually, of doing systematic reviews of very young children who are prescribed this medication so that they are identified and second opinions can be proposed and more in-depth assessments made. So I think there are means of doing this and actually there is concrete discussion about how to do it.
NNAMDIAgain, you can join the conversation by calling us at 800-433-8850. John, thank you very much for your call. How do you think we should be handling mental or behavioral issues in very young children? 800-433-8850, but you can also send us an e-mail to email@example.com. You can also send us a tweet at kojoshow. Duff Wilson, it's my understanding that you have heard from quite a few parents since your piece was published, saying that antipsychotic drugs had an overwhelmingly positive impact on their children. They feel you should tell the other side of the story.
WILSONTrue. And we received a huge response to this article a couple of weeks ago, over 400 responses of which, I would say, ten, maybe 15 were from parents who said, these drugs have really helped my little child, even a four-year-old in one case, you know, prevent them from hurting themselves, just, you know, bring the family life under control and, you know, kids who they feel strongly were properly diagnosed with bipolar or schizophrenia.
NNAMDIBut what sorts of pressures are doctors under to please parents who come to them and are, frankly, at their wits end? I imagine it's much easier to offer a quick fix in a case like Kyle's, Ben Vitiello.
VITIELLOYeah, it is, definitely. And we need to look at the context in which this situation actually are situated. As you mentioned, the preschool or even the babysitter may have refused to interact with the child unless there is a certain control of the behavior. And the parents must go to work so they are really -- they not have too many alternatives. And -- or actually, the alternatives are there, but are much more difficult. So there is an enormous pressure, I think, or inclinations to act and to act quickly.
NNAMDIDuff Wilson, any evidence of that in your reporting?
WILSONYeah, totally. I mean, I got all the medical records for Kyle with his mother's permission and I interviewed both the doctors who'd prescribed the antipsychotics at the age of one and two. And the pediatrician said that Kyle was just very aggressive and impossible to control or to reason with and he needed to prescribe that drug. And he quickly referred him to a child psychiatrist who also said that the mothers are so desperate for help, in some cases, of the -- of mothers he sees, that he takes it upon himself to prescribe the antipsychotic drug, which is not easy for him to do either.
NNAMDIWe're going to take a short break. When we come back, we'll continue this conversation. We're still taking your calls at 800-433-8850. How do you think we should be handling mental or behavioral issues in very young children? 800-433-8850. Send us a tweet at kojoshow. I'm Kojo Nnamdi.
NNAMDIWe're discussing children and antipsychotic drugs with Duff Wilson. He's a reporter with the New York Times. He joins us from the studios of NPR in New York City. In our Washington studio with us is Dr. Ben Vitiello. He is chief of the Child and Adolescent Treatment and Preventive Interventions Research branch at the National Institute of Mental Health. We go to Sam in Vienna, Va. Sam, you're on the air. Go ahead, please.
SAMHi, I have very vivid memories of when I was 10 years old and this was, like, 30 years ago, being given, you know, a drug. I believe it was Ritalin. And, you know, it made me feel totally dopey. And as a kid, you know, you go to your parents and say, I don't feel so good with this. They tell you, take it anyway. And I just think a lot of these drugs, you know, the kids don't have the maturity to be able to tell them the adverse affects of it. And the other point I'd like the speakers to address is the -- you know, there's a very strong relationship between depression and ADD. You know, and a lot of these drugs, like Adderall, in fact, you know, if the problem is really depression and not ADD, can make things worse. And that's all. Thank you.
NNAMDIHow long were you on Ritalin for, Sam? At what age did you stop taking it?
SAMOh, probably that year.
SAMYou know, it wasn't until months later that, you know, I was put on something else. And then, later after that they figured out that it wasn't ADD at all, it was something -- it was depression. And so now I don't take anything other than, you know, one drug. But, you know, it's -- the point is, is, you know, I think that there needs to be some way of telling, you know, how -- you know, especially how it, you know, whether a child is getting an adverse reaction from these drugs.
VITIELLOI think you bring up some very important issue. I mean, how do you assess possible aversive event of drugs in children, whose communication capacity is somewhat different from that of adults and they're not so articulate sometimes? And this is very important because as we go actually even younger in age, you are ten when they give the medication. But can you imagine a child who is five or four? Basically, we are really very limited in assessing what other possible adverse affects on the ability to think, to interact, to express. So I think your point is very well taken.
NNAMDIThank you very much for your call, Sam. Care to comment at all, Duff Wilson?
WILSONWell, I think that he makes an important point about the diagnosis at that age. Which is why it's especially important to look at the little kids or the kids in their use and the prescription of these antipsychotic drugs for them, as well as the very old people who rely on, you know, other people to decide their care.
NNAMDIAnd I guess there's a message there that you should also listen to your kids, Ben Vitiello, because Sam says it just made him feel bad.
VITIELLOExactly. We should listen to our kids and try to learn their language.
NNAMDIHere is Tracy in Bowie, Md. Tracy, you're on the air. Go ahead, please.
TRACYHi, am I there?
NNAMDIYou are here...
TRACYYeah, I have two children who have had issues with ADHD. They have -- one of them had antipsychotic drugs prescribed to her by an error because the doctor she was seeing erroneously diagnosed her as being bipolar. And my general comment is that this is very much a healthcare reform issue because insurance reimbursement rates for mental healthcare, in general, are very, very low, at least in the D.C. area. I obviously can't speak to the whole country. And relative to the actual cost of providing those services, they are, you know, somewhere in the neighborhood of, like, 60 percent versus, like, 80, 85 percent for your average internist.
TRACYAnd I'm -- so it's really -- there's a huge incentive on parents, generally, to go find a provider in network. And my experience has been that providers who work in network with insurance companies are overwhelmed with patients. They don't have time to really test and diagnose these kids. They end up just writing prescriptions for pills which may or may not be appropriate. With my own child -- I had -- my older child had a tantrum at the age of 18 months that was so violent, it got us thrown out of a building downtown Washington. And I felt very, very frightened and alone. My husband and I both did.
TRACYWe ended up taking her to Children's Hospital in D.C., which was a great place to take her. It was the only place that we could find that would test her, and thank God it was there, that participated with our insurance program. Private testing costs around $2,000, which is a hefty price tag for most middle class parents and one that they're very, very reluctant to fork over because they don't understand the importance of getting a thorough complete neuropsychiatric work up on these kids to try to figure out what's wrong.
NNAMDII'm glad you brought that issue up, Tracy. Because, Duff Wilson, we talked early about low income families that were being shunted to medication over family counseling. But Tracy makes the point that middle income families with private insurance could also end up with facing the same dilemma.
WILSONThat's true. Certainly in medicine and in psychiatry, there's much more medicating going on and much more of a pill culture than there used to be. Reimbursement rates, I think, are low for counseling, relative to the time it takes a psychiatrist as supposed to reimbursement for...
WILSON...drugs. Yeah. And, you know, you can imagine your problems. Imagine if you were in the Medicaid program and were shunted around to doctors who have to see hundreds of patients a week, how difficult that would be to get a proper diagnoses or care in some cases.
NNAMDITracy, thank you very much for your call. We move onto Nadia in Falls Church, Va. Nadia, you're on the air. Go ahead, please.
NADIAHi, Kojo, how are you?
NADIAI would just like to bring up the point, very briefly, that we should look at the nutritional aspect to those -- you know, maybe if we feed our children differently, their behavior might be different. I work with children and I also am a student of nutrition and naturopathy. And I find that children that are -- diet high in vegetables and fruits and whole grains tend to act differently than children who are on a diet that's high in sugar and carbs. And even children who are diagnosed with ADD or ADHD tend to do well with fish oil, for example.
NNAMDIHere is Dr. Ben Vitiello. We certainly know about the sugar aspect of it.
VITIELLOYeah, yeah, the sugar was considered to be a possible trigger of hyperactivity many years ago, but it's never been proven to be responsible for hyperactivity. But anyway, nutrition is very important. There is no question, as physical activity is important. And we know if you have balanced diet and you have adequate physical activity regularly in a child, the development would be better, including also mental health.
VITIELLOAs to the specific application of particular diet or intervention to treat, let's say, attention deficit disorder, bipolar disorder or depression, there the evidence is not very strong at the moment. There are just very interesting clues, very interesting hypothesis for this event of -- the omega 3 fatty acids, fish oil, which is certainly beneficial at some level. But still we don't know how affective actually is when you have really a full blown disorder, like what is -- or bipolar disorder. So interesting, but at the moment, we cannot really make any clear prescriptions, at least at this time.
NNAMDINadia, thank you for your call. Dr. Ben Vitiello is chief of the Child and Adolescent Treatment and Preventive Interventions Research branch and the National Institute of Mental Health. And Duff Wilson is a reporter with the New York Times. If you're interested in contributing to the conversation, call us at 800-433-8850. Duff Wilson, what role does the pharmaceutical industry play in this trend? To what extent are drug companies pushing doctors to consider these drugs for younger and younger children?
WILSONUnfortunately, most of the drug companies that sell antipsychotic drugs, you know, have been investigated and have had to repay money to the government for overselling them, to youth as well as to the elderly. However, you know, this isn't a big drug company conspiracy. These drugs are approved by the FDA for down to the age of 10 for some kids and, in a rare circumstance, down to the age of 5.
VITIELLOBut I would say -- I found in this child psychiatrist office in Louisiana -- this is a psychiatrist that handles a lot of Medicaid families, very busy practice. In his waiting area are these Lego toys that are branded with the name Risperdal, which is the antipsychotic drug that's made by Johnson & Johnson, so that these little kids, two and three-year-olds, who are playing with these Lego's that say Risperdal on them. And I was just amazed 'cause Risperdal is not approved for two or three-year-olds. So I asked Johnson & Johnson, what's up with the Risperdal Legos? And they -- after they got back to me, they said, well, those were promotional items for psychiatrists. Kids weren't supposed to play with them.
NNAMDIAnd who exactly was supposed to play with them, the psychiatrist?
WILSONI guess the psychiatrist was.
NNAMDII guess they put it down to overenthusiastic marketing, huh?
WILSONI guess so, yeah.
NNAMDIHere is Sara in Alexandria, Va. Sara, you're on the air. Go ahead, please.
SARAThank you Kojo. I have an eight-year-old daughter who has been diagnosed with ADD anxiety and phobia, as well as several other diagnoses. And I -- first of all, I wanted to say we are fortunate enough to -- I'm a stay-at-home Mom so I'm fortunate enough to be able to run around to all of the appointments that we do all the time, as well as -- we're able to have the means to pay for a lot of these services which does cost a lot on -- so even though -- it is stretching us so I appreciate the point that many have made there.
SARAAnd we are -- but currently, we are seeing a psychiatrist and we're considering a couple of different drugs for her, including Strattera and Remeron. I think one of the other ones, that was a Zoloft and Prozac, were mentioned as well. She was on Adderall this spring, by the way. Are those drugs -- are they in a different class? Are they anti-depressants versus antipsychotics or are they a subset of antipsychotics and do they have -- if they're different, then is there more of a track record with those than with the antipsychotics with young children? And my daughter's eight. I don't know if I mentioned that.
VITIELLOYeah, none of the medication that you mentioned are antipsychotics. Strattera, it's a medication that's related to -- chemically to anti-depressants, but it is approved for the treatment of attention deficit disorder. But anyway, chemically it pharmacologically acts like an anti-depressant. And then, Remeron, Zoloft and Prozac, that also you mentioned, they're all anti-depressants. Zoloft is approved by the Food and Drugs Administration for the treatment of obsessive compulsive disorder and Prozac also for the treatment of obsessive compulsive disorder and also depression starting age eight. So we have, as you said, more information about these drugs than about antipsychotics for this age.
NNAMDISara, thank you for your call. We got this e-mail from Donna in Bethesda. "I'd like to know what you have found as you treat children who have been put on drugs at an early age for ADHD? Do these children tend to experiment and become more addictive to illegal drugs as they get into their teen years? I wonder if children who have never had the opportunity to work through behavior problems without drugs and do not know how to cope without drugs are always looking for a drug to cure their problems."
VITIELLOYeah, this is a very good question. That actually has been around for at least 10 years. People have been wondering, if we use medication like Ritalin, that we know are drugs of potential abuse, to treat children with attention deficit disorder, are we, first of all, sensitizing their brain in some ways so that they become more prone to abuse drugs later on? And number two, are we giving them the message that you need to fix the problem by using medications? So there has been a number of studies to try to address this question.
VITIELLONo study is perfect because it's -- no study can be done in a very controlled way as you would like to do it. The majority of the data that we have, we'll say the predominance of evidence indicates that if this drug is used therapeutically at the right doses in the right context with the right supervision by the parents, it doesn't lead to a higher risk for substance abuse as these children grow up and become adolescent or young adult. But exceptions always can exist. And again, you know, there is no perfect study that has settled the issue for good.
NNAMDISpeaking of the pharmaceutical industry in terms of the question I raised earlier, Ben Vitiello, in your view, are there any regulatory changes that should be made to the way drugs are marketed to children? I commented earlier that that seemed to be overzealous marketing on the part of the Risperdal people.
VITIELLOWell, I don't really have expertise in the regulatory aspect so I can't really comment on that. I know that, since 1998, the Food and Drug Administration has actually given more incentives to the pharmaceutical industry to conduct research on drugs that were being used off label in children. Therefore, without the adequate advocacy and safety information and this regulatory function, that actually was mandated by a law of Congress, has been quite affective in generating more information and more data.
NNAMDIYou know of any regulations in the works, Duff Wilson?
WILSONThe FDA has a regulatory office that's supposed to watch excessive advertising and promotion. I don't know of any laws in the works. I think it's great to have Ben Vitiello on this show because he's an evidence guy. He's an expert in this area. And at the National Institute of Mental Health, he's -- I think he's in the loop of a lot of the federal funding that goes into actual, you know, developing evidence in this area for the little kids.
NNAMDIHere is Judith in Washington, D.C. Judith, your turn. Go ahead, please.
JUDITHHi. I have raised -- am raising a child, he's now a young adult, who was diagnosed -- first diagnosed at 18 months as having ADD and, you know, that had depression. And we are fortunate to have strong health insurance, fortunate to be in a situation where I could stay at home, also hire an au pair so that we could manage our other two children along with him. And I don't think there has been a year since he was 18 months where we have not spent $30,000 up and above our reimbursements on all the therapies, all the medications.
JUDITHYou know, we kept him off the antipsychotics, but the cost of doing that, of putting him in private schools, of changing the private schools, of the therapists, of the family therapy, the therapy for the other kids were being impacted, of all that, is enormous. And I think, you know, when you talk about people taking a, you know, cheap way out, essentially, you know, it -- even people who have pretty good incomes, if both people have to work, if you have a kid who is seriously depressed, who's seriously disruptive, it is more than a full-time job.
JUDITHIt is just an incredible burden on a family. And I think, you know, it's easy to kind of blame the psychiatrists, but I think that, in many ways, the psychiatrists are trying to help people who are so incredibly overwhelmed, especially if there are other kids, you know, who are incredibly impacted by a child who's out of control, who's tantruming, who's, you know...
NNAMDIJudith -- Judith, has your child been treated both with therapy and with medication?
JUDITHYes. Since he was 18 months, he's been on medication. He's never been on antipsychotics. But the only reason he has not been on antipsychotics is just because we have been adamant and have put -- I mean, when he was little, there was not a day of the week where he did not see a therapist after being in a therapeutic preschool.
NNAMDIAnd you have been adamant about not having him prescribed with psychotic drugs?
JUDITHBut at enormous cost. And I don't believe -- I mean, he's now old enough and I can say I don't think he was psychotic. He's not manic-depressive. He's depressive. He has ADD. He still has incredible anger issues.
NNAMDISo it would have been -- it would have been much less expensive for you if you had gone the route of antipsychotic drugs, but as the case of Kyle seems to indicate, Duff Wilson, that may not necessarily have helped Judith's son.
WILSONThe drugs, no. As she notes -- and what a situation you've got there. You know, your child was not psychotic, but it was very difficult for the family and everyone to control. And, you know, one of the side effects of antipsychotic drugs is a sedative. So it's used by parents who don't have the time and resources that you may have, I think, to sedate their kids, in some cases, or to help them sleep or to address the attention deficit problems that they perceive.
WILSONSo I just think it's wonderful that you've had the time to help your children. In this case in Louisiana, it wasn't until the model program helped the mother, Brandy Warren, and helped to wean Kyle off these drugs and surrounded them with counseling. It wasn't until that, that he was able to resume a normal life at about age five.
NNAMDIAnd Dr. Ben Vitiello, you hear Judith's story, but she seems to have had no alternative.
VITIELLOWell, I think we all need to, in this debate, to appreciate and to acknowledge that there is an enormous burden on parents when you have a child that, for one reason or the other, suffers from some severe mental condition or developmental disorder, if this is autism, if it's cognitive delay or depression or whatever. So indeed, you know, these parents are very often overwhelmed, very often depressed themselves. And we need to find better ways of treating the family and not just the child.
NNAMDIWe're going to get back to that, but first we have to take a short break. If you called, stay on the line. We'll try to get to your calls. If the lines are busy, try going to our website, kojoshow.org, asking a question or making a comment there. I'm Kojo Nnamdi.
NNAMDIWe're discussing antipsychotic drugs and their use by children with Duff Wilson, he's a reporter for the New York Times and Dr. Ben Vitiello, chief of the Child and Adolescent Treatment and Preventive Interventions Research branch at the National Institute of Mental Health. We got this e-mail from Catherine in Bowie, Md. "I have two children who have been on antipsychotics. I'm very concerned about possible side effects, but I'm much more concerned about their quality of life without the drug, and my entire family's well-being without the drug. One of my children has been diagnosed with bipolar and has since been taken off the antipsychotic. But without them, life was painful.
NNAMDII think that for people who have not had a struggle with a bi-polar child, it's very easy to say they should not be given these drugs at such a young age. My daughter was started on the drug at six years old. She is now 11 and thriving. The message I have learned is that quality of life with the drug can outweigh risk of side effects." What do you say to that, Ben Vitiello?
VITIELLOThat, I think, is a very important point. There's always a balance between the benefits and risk and adverse effects. And that determination, if the balance is favorable, meaning there is more to gain than to risk, in terms of side effects, must be made between individual childs -- between individual patients. So it's a work that each clinician, each family needs to make, and to put everything together, all the information.
VITIELLOWhat actually do we gain from taking this medication? What are the possible adverse effects? What are the risks of the medication? So that work needs to be done repeatedly and to be revisited periodically during treatment, if a treatment is chronic and lasts months or sometimes years.
NNAMDIDuff Wilson, this question for you because it may relate to Kyle's case. This from Scott in Falls Church. "Are you aware of any co-relation between the age of the parents, particularly the mother, and the children that are prescribed these drugs? Is this perhaps a pharmaceutical solution to a problem that may be more training or experiential in nature?"
WILSONYou mean is the mother too young and unprepared and unable to handle the child? If that’s what he means...
NNAMDII guess that's what he means.
WILSONYeah. That was certainly the case with Brandy. She was just 22 when she had Kyle and she admits she was unprepared for parenthood, kind of. She was not able to handle him as well as she can now. I don't know if there's any research on that. I bet you Dr. Vitiello would know if there's any research.
VITIELLONot that I'm aware. But what you're saying basically makes sense and you will -- probably you will suspect that there is an association between a young, inexperienced, overwhelmed parents and use of these medications.
NNAMDIOn to Ingrid in Ellicott City, Md. Ingrid, you're on the air. Go ahead, please.
INGRIDHello. I love the topic today. I'm actually a certified guidance counselor and I remember vividly a case that I had of a seven-year-old who was on 70 milligrams of Ritalin for his ADHD and he came from a very abusive background. I was actually wavering. I wasn't always sure how much was ADHD versus childhood depression, but the mother refused to get him counseling. The Ritalin didn't seem to help his behavior so I was always torn whether or not there were more issues going on. But being that I was in schools, I could only do so much.
INGRIDBut my question is actually for Dr. Vitiello. Basically, number one, do you feel that kids are being medicated more often now for seemingly quick behavior fixes? And when is it really too young to medicate or even diagnose? Because two callers back, at 18 months, they diagnosed ADD. What about these kids that are just, you know, high energy -- high needs kids?
VITIELLOYeah. So you bring up the issue of early diagnosis. And really it -- in very young age, like 18 months, 24 months, you can make probably a diagnosis of autism. But in terms of attention deficit disorder, really it's too early. You can probably diagnose someone with severe attention deficit disorder starting age three or older. And at that point, sometimes treatment, in very exceptional cases, can be indicated also in such a young age. In terms of the fact is this a more frequent phenomenon? Yes. There is evidence that over the past, let's say, 10, 15 years, there has been an increased use of these medications also in very young children.
VITIELLOSo it is a general phenomenon, but it's probably driven by different factors. The misperception that these drugs are safe or safer than other drugs that we had before, a misperception that we can be precise in making diagnosis at such a young age, which is not the case. So there are a number of factors that contribute to the phenomenon.
NNAMDIDuff Wilson, Ingrid also talked about family therapy. And you mentioned how Kyle's situation changed after he entered that special program in the state of Louisiana. It's my understanding it is called Early Childhood Support and Services. It surrounds families with social and mental health support services and that's what helped Kyle. Is that kind of approach being used elsewhere, as far as you know, or is it fairly unique?
WILSONThey think that their program in Louisiana, and just part of Louisiana, is unique. So it's kind of a test program or a model program, if you well. It's very expensive to bring all these services to, you know, low income families. We talked to the parent earlier that was spending over $30,000 a year on her child and it's just expensive for the government as well.
NNAMDIIngrid, thank you for your call. Here is Judy in McLean, Va. Judy, your turn.
JUDYHi. I know that NASA has been using lasers in many forms and vibrations in healing and treatment and experimentation and then kind of -- it's gotten into some mainstream equipment. And I personally have a laser that I use for all sorts of healing and it didn't -- the frequency can be directed to your internal organs. And I just wonder if anyone's done any research on this with kids with these problems.
VITIELLONo. I'm not aware of any research going on in laser therapy for mental illness. And I would be very cautious because laser can cause adverse events and so I will not use it at the moment, unless specific evidence, which I don't think it exists.
NNAMDIThank you for your call, Judy. Duff Wilson, you were going to say?
WILSONOh, I was just going to actually ask Dr. Vitiello about other research because he's the research guy in this area.
WILSONDr. Greenhill, who is the president of the American Academy of Child and Adolescent Psychiatry, thinks that there should be a registry for the smallest kids put on antipsychotic drugs, the two to five year olds, a registry to track all of them or at least a lot of them in this country over a ten-year period to see what really happens to them, in terms of their behavior and the side effects. But he says that, you know, that would be like a breast cancer registry that we have going. But he says that that would cost a lot of money and -- but it would provide a lot of answers, too. So I wonder from Dr. Vitiello, any chance of that?
VITIELLOI agree with Dr. Greenhill that that could be a very good way of providing a database that eventually can be informative. So I totally agree. Inventories have been used for medications in other areas, like, for instance, to study the effect of medication during pregnancy. Women who become pregnant while talking a medication, they enter a registry for some medications to follow up with the children and to make sure that the drug did not cause any adverse effects. So in this particular case, this database could be quite useful.
NNAMDIOn now to Mark in Gambrills, Md. Mark, you're on the air. Go ahead, please.
MARKI have a grandson who, at the age of eight years old, was diagnosed with ADHD, depression and anger issues and was on a cornucopia of drugs for three years until some doctor finally decided to CAT scan his brain where they found a tumor on his pituitary gland, which seems to have been causing the whole thing. So I think a lot of cases are under diagnosed. Yes? No?
VITIELLOWell, you know, if a case that you present is quite striking and I think it is a good example that we should not ignore the possibility that there is something really specific, something growing in the brain. Now, a neurological examination oftentimes is a good way of ruling out the possibility of some problems within the brain. Other times it is surprise. It cannot be ruled out altogether. But thank you for sharing this case. I think it's quite good to know. We should keep it in mind, that that's a possibility.
NNAMDIThank you very much for your call, Mark. We're almost out of time, Ben Vitiello. But as it becomes more common for doctors to prescribe these drugs, do we find ourselves in a situation where it's impossible to go back to where we were before and this just becomes a fact of life for many American families? And in other words, once this Pandora's box is open, can it be closed again?
VITIELLOYou're asking me to take a philosophical...
NNAMDIYes. Take a look into the future.
VITIELLOI don't know. I think one element that we need to keep in mind to try to explain this phenomenon is that in the last 10, 15 years, we have come to realize that a lot of these mental disorders that we thought were just adult disorders indeed are developmental problems. They start, indeed, in the first two decades of life. And so that fact will condition our way of thinking and looking at mental illness and probably will drive us toward the use of biological, medical, pharmacological intervention. I only hope the research will be more precise, it will allow us to use this drug more effectively.
NNAMDIDr. Vitiello is chief of the Child and Adolescent Treatment and Preventive Interventions Research branch at the National Institute of Mental Health. Thank you for joining us.
NNAMDIDuff Wilson is a reporter with the New York Times. Duff Wilson, thank you for joining us.
WILSONThank you, Kojo.
NNAMDI"The Kojo Nnamdi Show" is produced by Diane Vogel, Brendan Sweeney, Tara Boyle, Michael Martinez, and Ingalisa Schrobsdorff. Diane Vogel is the managing producer. The engineer today, our own T-O, Timmy Olmstead. Dorie Anisman has been on the phones. Thank you all for listening. I'm Kojo Nnamdi.
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