Myths and facts article

Are Psychiatric Disorders Over-diagnosed in Children?
Are Medicines Over-prescribed?
13 Myths & Facts
(Originally appeared in Four Winds Hospital Mental Health News-Fall, ‘09)
Headlines scream that too many kids are taking Ritalin or Adderall or whatever the latest
ADHD medicine du jour is. TV’s talking heads complain that we’re drugging our kids
with Prozac, Zoloft and other “dangerous drugs.” But your child’s teacher recommends
your child be “evaluated”-a code word that tells you to consider medicine. And mental
health professionals tout medicine’s benefits. What’s a parent to do?
Parents are understandably confused and frustrated. Are these medicines over-
prescribed? If I consent to medicine, will my child become a statistic? If I don’t, am I
withholding needed treatment?
Let’s trash the myths and examine the facts.
Myth #1 Children do not suffer with psychiatric disorders.
Fact: While we like to think of childhood as a simple time, a bastion of happiness, it is
not for all children. Research has shown that about 20% of children and adolescents have
a psychiatric disorder and about half of these have a disorder which disables them.
Myth #2 Psychiatrists invent psychiatric disorders at the drop of a hat.
Fact: Psychiatric disorders are based on years of research and much debate. Even with
all the research, are these disorders evolving concepts? Absolutely. Research is
painstaking and takes years, so our understanding of these disorders changes slowly.
Some doctors are more liberal in applying the criteria for a particular disorder and others
more conservative. This can frustrate parents who receive different opinions from
different physicians. Bipolar Disorder is a perfect example. What Bipolar Disorder
looks like in children has been debated for the past decade or so. Some doctors apply a
broader set of criteria and others a narrower set. The final word has yet to be determined.
Myth #3 When I was a boy, nobody had these disorders.
Fact: When I was a boy, children had these disorders, they simply were not recognized
or the kids were labeled “bad seeds” and the like. Truth is, if I look back to elementary
school, even decades later, I can pick out at least some of the kids who would have been
given a diagnosis today.
Myth # 4 Psychiatric disorders are not real illnesses with real bad consequences.
Fact: Psychiatric illnesses carry what doctors call significant morbidity and mortality.
That is they can be debilitating and deadly. For example, 5-10% of depressed
adolescents will commit suicide over the next 15 years. If your child’s doctor told you
that there was a 5-10% chance that your child’s illness could be fatal before they were 30,
you would not hesitate to pursue treatment aggressively. Other disorders, like Anxiety
disorders, while less lethal, also adversely affect a child’s functioning. Some of my
patients are unable to attend school, go to a friend’s house or even leave home because of
anxiety. And, ADHD is associated with higher rates of Emergency Room visits, medical
costs, traffic accidents among teens, cigarette smoking, early pregnancy, divorce, job
changes, and dropping out of high school. While some of these risks are probably higher
among youth with ADHD combined with certain other disorders, I’d say ADHD could be
a fairly nasty disorder.
Myth #5 Anyone can have a little bit of ADHD or OCD.
Fact: We all have characteristics that make us who we are. Some of us are a
bit more fidgety and others more slow moving. Some are fastidious and
others are a mess. But, for those with a disorder, the characteristic has
become a symptom, something that significantly interferes with the person’s

Myth #6 Psychiatric disorders are caused by bad parenting.
Fact: Parenting has an important and unique impact on child development, but children
also come into the world with biological propensities and risks. For example, researchers
at NYU showed that about 15% of children were characterized as being Slow to Warm.
That is, when a stranger was present, they clung to their mothers, eyes open wide and
saying nothing. Researchers at Harvard showed that similar children had faster heart
rates and more dilated pupils during a problem solving task and that about 1/3 of them
would go on to have Social Anxiety Disorder as teens. More recent research is
demonstrating that a part of the brain called the amygdala is also different in children
with anxiety disorders.
Myth #7 More kids are using psychiatric medicine than ever before.
Fact: Just want to keep you awake. That last one is actually a fact. Over the past 20
years, the number of prescriptions given to children and adolescents has increased
considerably, perhaps 2, 3, or 4 times the rate in the 1980’s. But, the number of children
using cell phones and laptops has also increased dramatically. Like these other
innovations, other than Ritalin, most of the medicines used in child psychiatry were not
around until the very late 1980’s or even later.
Myth #8 Most kids today take a psychiatric medicine.
Fact: The overwhelming majority of children do no take any of these medicines.
National studies demonstrate that about 5% of children are given a prescription for a
stimulant, such as Ritalin or Adderall. About 2% of children are treated with
antidepressants. And about 1% or fewer are treated with other psychiatric medicines.
Myth #9 Children become addicted to psychiatric medicines
Fact: While some of the medicines used in psychiatry, such as stimulants, like Ritalin, or
the anti-anxiety medicines, like Xanax, are addictive when used inappropriately, such as
used at too high a dose, the responsible, physician-managed use of these medicines does
not lead to addiction in children. In fact, research suggests that taking stimulants lowers
the risk of drug and alcohol abuse among young people with ADHD.
Myth #10 Never take a medicine that isn’t FDA approved for the condition you’re
Fact: The FDA approves of medicines for a specific age group and a specific condition.
If the patient is not in that age group or does not have the specified condition, the use of
the medicine is called “off-label.” Medicines are used off-label everyday by all
physicians. This is legal and ethical. In fact, about 70% of all medicines (including non-
psychiatric medicines) prescribed to children are off-label. A medicine can be very
effective, but still off-label. For example, the use of the SSRI’s, such as Prozac, for
anxiety disorders in children is off-label. There are many reasons a medicine might not
have FDA indication for a specific disorder for a specific age group. But, over recent
years, the government is trying to encourage pharmaceutical companies to research the
use of medicines in children and apply for FDA approval for children.
Myth #11 Never take a medicine that has the FDA’s Black Box warning!

Fact: A Black Box warning is the FDA’s strongest way of pointing out that
a medicine has a certain risk. The FDA still approves of the use of the
medicine for treating a specific age group with a particular disorder. Some
of the side effects that are given black box warnings are rare. The specifics
must be discussed with one’s physician.
Myth #12 If medicine helps, it’s the only treatment my child needs.
Fact: Research has shown that while medicine is effective for the treatment
of ADHD and Depression, treatment with medicine combined with a
behavioral treatment, such as Cognitive Behavioral Therapy (CBT), is more
effective. For disorders such as Obsessive Compulsive Disorder, CBT has
been shown to be at least equally effective as medicine and perhaps more
effective in the long run. For OCD, a combination of these treatments seems
best of all. Many parents also benefit from counseling that teaches them
how to deal with their child’s difficulties, regardless of whether their child
takes medicine.

Myth #13
Too many children are taking medicines, like Ritalin and Prozac.
Fact: Some children are given psychiatric medicine too quickly when another treatment
might be indicated. For example, cognitive behavioral therapy should always be
considered for children with anxiety disorders or Obsessive Compulsive Disorder.
However, other children would benefit greatly from medicine and never receive it. For
example, about half of children with ADHD are not treated with stimulants which could
be very effective.
In short, medicines are probably over prescribed to some and under prescribed to others.
However, parents should be neither fearful, nor cavalier, about psychiatric medicine.
Rather, with their physician, they must weigh the risks and benefits of medicine against
those of other treatments and against those of not treating at all. Then, with their child in
the balance, they will decide on the best course.


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