More Children Now Taking Psychiatric Drugs

Jan 14, 2003
By SHANKAR VEDANTAM The Washington Post

The number of American children being treated with psychiatric drugs has grown sharply in the past 15 years, tripling from 1987 to 1996 and showing no sign of slowing down, researchers said Monday.

A newly published study, the most comprehensive to date, found that by 1996 more than 6 percent of children were taking drugs such as Prozac, Ritalin and Risperdal, and the researchers said the trajectory continued to rise through 2000.

While the increase partly may reflect better diagnosis of mental illness in children, the authors said they fear that cost-saving techniques by insurance companies, marketing by the pharmaceutical industry and increased demands on parents and doctors may be driving the steep rise.

``There are fewer options other than medication,'' said Michael Jellinek, chief of child psychiatry at Massachusetts General Hospital, who reviewed the new study.

Health insurers have increased their profits by decreasing the use of psychotherapy, which is more expensive than medicines in the short run, he said. ``The insurance system gave an incentive for medications and a disincentive for therapy.''


Debate Over Behavioral Change

The insurance industry disputes that interpretation, suggesting instead that more children are getting drugs because more effective medicines have been developed. Most psychiatrists say a combination of psychotherapy and medication often provides the best treatment.

The new research found steep increases in the use of most classes of medicines, including antipsychotic drugs. Such powerful medications, normally meant to treat schizophrenia, increasingly were being prescribed to children on Medicaid, possibly as a way to restrain difficult children, said the study's lead author, Julie Zito.

``Other than zonking you, we don't know that behavioral management by drug control is the way to learn to behave properly,'' said Zito, a researcher at the University of Maryland in Baltimore. ``If we are using drugs to control behavior, that doesn't change the underlying problem if someone doesn't know how to get along with their peers.''

Zito's study evaluated 900,000 children on Medicaid in a Midwestern state and a mid-Atlantic state and in a private HMO in the Northwest. Zito said the large size of her study made it likely the data is representative of the whole nation. A re-evaluation of one of the health plans in 2000 found the steep rate of increase had continued, she added.

``The medicine may help the symptoms but not address issues of self-esteem, interpersonal relationships and family relationships - all of which are part of recovery,'' said Jellinek, who analyzed Zito's study. In obsessive compulsive disorder, for example, he said, ``you can get a lot of benefit from behavioral treatments. If someone is getting medicines for OCD, I would like to see them be given a trial of behavioral therapy to see if that helps them and maybe decrease the medication.''

Both Zito's study and Jellinek's analysis were published Monday in the Archives of Pediatrics and Adolescent Medicine.


Quality Of Care Not Examined

Susan Pisano, vice president of communications at the American Association of Health Plans, whose members provide managed care to some 160 million people, said the study did not address the quality of the care children received.

``The research doesn't say, `There is a greater use of drugs and that's having a deleterious effect on children,' '' she said. ``It just says there is a greater use of drugs.'' Pisano said more analysis was needed to answer the quality question.

Zito agreed her study could not answer the question of whether the trend represented a growing awareness of mental illness or was evidence of overmedication and mistreatment. That's because she tracked medication records, not individual children. Without comprehensive studies that tracked the outcome of medication treatment of actual children, she and Jellinek said it was difficult to say whether the children were getting the right treatment.

Noting that children are being medicated at almost the same rate as adults, Zito pointed out that few safety studies of the drugs have been done in children. Zito said there is a need for a public health center to monitor medicine use across the nation on a long-term basis.

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