Kids, Docs, and Drugs
A Walnut Creek doctor on the front lines of treating emotinally fragile kids offers his take on medicating young patients
With America’s craze to treat hyper or moody kids with drugs coming under increasing scrutiny, Diablo talked over the issues with behavioral/developmental pediatrician Lawrence Diller, author of the best-selling book Running on Ritalin and the more recent Should I Medicate My Child?
DIABLO: Should we medicate children with emotional or behavioral problems?
DILLER: There’s a place for these medications, but we often rush to use them. A drug like Ritalin may improve a child’s behavior at school or at home, but it isn’t the moral equivalent of assisting the family or the school to address kids’ needs. There are higher moral questions to be addressed with the pediatric population, because kids don’t make these decisions themselves.
DIABLO: Are we overmedicating our kids?
When you compare us to other countries, we use [far more] psychiatric
medications. There is a simplistic belief in the biological model of
mental illness. It tends to ignore environmental factors. Most of these
problems are not so categorical.
DIABLO: Is stress causing kids to act out?
I think there are increased educational demands on children. With two
working parents, there’s no one home in the afternoon, and the parents
are tired in the evening. Another factor is an erosion of discipline
that started 150 years ago and accelerated in the last 10 or 20 years.
DIABLO: How can parents know if their child needs medication?
DILLER:Talk to people you trust in your family. Grandparents, in particular, have lots of wisdom. Beyond that, your pediatrician is the first place to go. Medication is an option when you’ve really tried cognitive behavioral approaches or educational interventions and the problems persist. And when you consult with an M.D., I would ask him about his biases, how much he medicates.
DIABLO: You talk about the importance of having a child undergo "a complete and ethical evaluation." What is that?
It involves getting a good history from both parents. I have one family
visit with my patients, and I find that it is exceedingly
helpful. If there are any issues at school, I
talk to the teacher or counselor directly.
DIABLO: Is it risky to use Ritalin or similar drugs to treat attention disorders?
Seventy years of experience with Ritalin-type drugs suggests that they
are quite safe. They’ve also been proven to be short-term effective. My
objection is that we use them in place of parenting and educational
interventions, and that we have a growing intolerance for temperamental
and talent diversity.
DIABLO: With reports of suicidal behavior associated with antidepressants, should kids even take them?
DILLER: We don’t have evidence that [these types of drugs] are effective in children, so, morally, it becomes even dicier to prescribe them [than Ritalin-type drugs]. We have better evidence that they benefit kids with anxiety and obsessive-compulsive disorder. But even with these kids, we [can turn to] great nondrug interventions. [However,] I would consider prescribing to a teen who had just tried to kill himself, who was found mutilating himself, or who was stuck at home and not going to school.
DIABLO: Are there risks to not medicating kids with psychiatric disorders?
We don’t know. We have no evidence that these drugs change long-term outcomes.
DIABLO: What should parents know about the pharmaceutical industry?
I feel like the drug industry has hijacked American academic medicine,
particularly psychiatry. I get all these journals … and at the bottom,
it says the research was funded by a drug company.
DIABLO: What about the Bush administration’s proposed universal mental health screening in schools?
DILLER:I’m very uneasy about it. Working through the schools is a great idea. But in this case, I think children will be diagnosed solely by their symptoms, and no one will address the family, neighborhood, and cultural aspects of these symptoms. �