Once again the increasing use of psychiatric medications for very young children, under the age of 3, has appeared in the news. A different journalist, but a similar story.
The use of these medications in infants and toddlers was first sounded during a Senate hearing chaired by U.S. Senator Tom Carper of Delaware in December 2011. Of particular concern was the use of these medicines in foster children as a means of managing behavioral challenges. Unfortunately, more than 40 percent of children going into foster care are in the infant to preschool age range and have frequently experienced childhood trauma.
In the most recent New York Times article, however, the story emphasizes that the use of stronger medications – atypical anti-psychotic drugs such as Risperdal or Seroquel and antidepressants such as Prozac – is increasing nationally. The problem continues to grow despite the Senate hearings, efforts by state social service agencies to control these prescriptions, and news outlet coverage of the issue.
There are three major concerns about the use of these medicines, which have never been systematically evaluated in young children:
1. The impact on normal development is unknown: We don't know the impact of these medicines as they affect brain chemistry on the very rapidly developing brain and behavioral skills of children in this age range. There are no human studies or any reasonable animal models to evaluate this question. We can only logically assume that altering brain chemistry in a system that is under construction will result in very unpredictable outcomes.
2. Future Health Risks: There are established metabolic side effects including rapid weight gain associated with these medications. Since many of the children who are prescribed these drugs come from disadvantaged communities, they are already at risk for the development of obesity-related disorders such as Type II diabetes, and these potentially can worsens those risks.
3. Not a permanent fix: These medicines simply suppress the disruptive behavior. They do not bring about permanent change. Use of these medicines defers or delays the recommended and effective treatment options. Parents, foster parents, and guardians often visit the pediatrician's office in severe distress due to the child's behavior. A well-intentioned pediatrician recognizing a parent in a crisis that needs to be addressed reaches for a pharmacological fix. In a health system that reinforces prescription first-interventions, this temporary fix can could become a longer term Band-Aid. Without additional psychotherapy, the disruptive behavior will return once the medication is discontinued.
The alternative to a pharmacological prescriptions for a child's disruptive behavior is both addressing the social and environmental stressors on the family, as well as giving parents the tools to manage the child's behavior and re-framing the interaction between the two. By learning parenting techniques that better suits the child's needs parents are empowered, the relationship improves, and child behavior improves.
The rapid growth in the rate of these prescriptions should be considered a warning sign as to what is happening with our young children. There are record levels of poverty in children and an increase of single parent homes. For our current young parents, the millennial generation, they have just been through seven years of economic upheaval, making their world less stable and predictable.
For most young parents, reliable, safe and supportive child care is essential to maintaining the parent's employment. A child with aggressive or acting out behavior can easily be expelled, thus threatening the parent's job, and the family stability. It is those economic and social pressures, along with a lack of access to mental health services that put pressure on physicians to write prescriptions to address these problems.
What is needed are early education centers providing day care that are equipped or have access to mental health consultants to help when problems occur, so that these centers can work with the parents to solve the problems. Parents also need access to the known effective therapies that help improve their parenting skills and the child behaviors. Decades of well run, National Institute of Mental Health funded research show clearly that programs such as Parent Child Interaction Therapy, and Incredible Years work, but primary health care providers rarely know about that work, nor do they have access to mental health providers trained in those therapies.
What is also needed is better support for child care providers, and parents in helping children who have these problems. This is not a medical problem. This is not a brain chemistry problem. These problems have social, psychological, and in some cases biological factors. All must be addressed to solve the problem. The medications can temporarily suppress and delay true treatment. In very rare cases, these medicines may be needed to handle a crisis situation. But Instead of thinking about these medicines as treatment, we should think of them as simply a way to briefly open the door to allow the real treatment, the therapies, to begin.
Some programs to consider include: