Saturday, May 17, 2014

The 2-year-old as ADHD Lab Rat

No one, including the American Academy of Pediatrics and the Centers for Disease Control and Prevention, is looking favorably at the fate currently meted out to 2-3-year-old toddlers. What fate am I referring to? Why, of course, it’s the need to control that awful scourge Attention Deficit Hyperactivity Disorder lovingly known as ADHD. No one knows how much damage is being done to the thousands of children in that age range who are now being prescribed potentially growth and brain damaging drugs for their purported diagnosis.

Recently, I interviewed Dr. Allen Frances, a highly respected psychiatrist, Professor Emeritus at Duke University and a former chair on a committee formulating guidelines for psychiatric diagnoses.  The article pertained to the overmedicating of the American public and ADHD in children in particular.

Pulling no punches, Dr. Frances said:  “The biggest upsurge in drug company success has been in saturating kids with medication. And for kids, we don’t have any long-term studies to indicate what the effects will be in 10, 20 or 30 years. Even beyond that is what they’re recommending for children without any information about these long-term effects.“ That statement along should be sending some kind of reaction down your spine. If it didn’t, consider what else Dr. Frances said.

Frances went on to the current state of child psychiatry (and remember 70% of all psychiatric meds aren’t provided by psychiatrists) when he indicated that, “The experts in the field in child psychiatry and psychology are just out of control. We should be doing something regarding the loose diagnosis of things like ADHD. In some instances, it is an appropriate diagnosis…”

How out of control are things? Forget about the fact that the guidelines for prescribing ADHD meds or giving a diagnosis to toddlers just aren’t there and think about some of the statistics recently released.  Toddlers with Medicaid coverage would seem to be serving as the experimental subjects or lab rats, if you prefer, for testing out powerful stimulant medication. Medications, mind you, in the bodies and brains that are undergoing incredible growth spurts until the mid-20s.

How many toddlers are involved in this somewhat suspect, ill-informed off-label approach to this serious diagnosis and how many are getting these meds? The CDC found that overall in the US 11 percent of kids 4-17 received the diagnosis and 1 in 5 boys will be the recipients of the diagnosis during their childhood. But these are kids who are within the guidelines and toddlers aren’t, remember? The current figure for toddlers on these addictive, stimulant meds stands at 10,000.  Is that all of them? No because they were only talking about records they could access, not the ones in peds’ offices where private pay is used.

Commenting on this, one expert, Dr. Lawrence H. Diller, stated that, “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.” Here, however, yet another interesting question pokes its hairy head upward into our conscience. When will the “wrong” occur and will anyone be able to point to the meds as the culprit? That is the question on which lawyers will hang their well-compensated cases.

Forget about wrong and stick with the stats and the sloppy prescribing that appears to be occurring here. What’s the drill? Parents don’t know how to parent, no help is offered for behavioral interventions to address problems and the kids are on Medicaid. The last fact most probably means the families don’t have money and the places where they’re diagnosed don’t have staff or training programs. It’s scripting all the way home for these kids.

Want to sum up this sorry situation? Return to what Dr. Frances said to me again. “We’re seeing childhood behavior as a disease. I hope this is the tipping point where people see how absurd it is, and they begin to realize that this has become a farce.”

Childhood as a disease? Interesting concept and it would certainly fit into all this medicating of toddlers activity. How many toddlers have you seen who can behave? How many of them hit, bit or scratch others and how many of them seem too unruly to be kept in pre-school? Yes, a lot of them and yet it isn’t necessarily a disorder or disease. Don’t you just love the power of that word “disease?” It makes everything seem so simple and biological. But it’s not. Kids act out, try to test the boundaries and establish their personalities within the guidelines of the home in which they live.

Being on Medicaid may mean living in a truly stressful environment because of all the financial problems and the unmet dreams and wishes of any family. But it doesn’t mean that putting a chemical straitjacket on toddlers is a good or even safe thing to do. I don’t care if a person with an advanced medical degree wrote a script for the meds. What do they really know, are they following good medical practice or just acceding to the wishes of overwhelmed parents? Being a parent is never easy. It’s one of the toughest jobs anyone will ever have and it’s a job they’ll have for life.

Sacrificing a child’s future for the sole purpose of appeasing a harried parent or because you are a really bad clinician doesn’t seem to be something we should shrug off. Who will speak for these children who have very limited language and, certainly, couldn’t hold their own in a moot court situation.