Meds for Preschoolers

Disturbing story by Duff Wilson at the NY Times about the increase in prescribing powerful antipsychotic drugs to young children. According to Wilson, prescriptions of antipsychotics for preschoolers has more than doubled since 2000. Consider Kyle, a boy who was diagnosed as bipolar at 18 months old:

Dr. Mary Margaret Gleason, a professor of pediatrics and child psychiatry at Tulane who treated Kyle from ages 3 to 5 as he was weaned off the heavy medications, said there was no valid medical reason to give antipsychotic drugs to the boy, or virtually any other 2-year-old. “It’s disturbing,” she said.

Dr. Gleason says Kyle’s current status proves he probably never had bipolar disorder, autism or psychosis. His doctors now say Kyle’s tantrums arose from family turmoil and language delays, not any of the diagnoses used to justify antipsychotics.

“I will never, ever let my children be put on these drugs again,” said Ms. Warren, 28, choking back tears. “I didn’t realize what I was doing.”

Dr. Edgardo R. Concepcion, the first child psychiatrist to treat Kyle, said he believed the drugs could help bipolar disorder in little children. “It’s not easy to do this and prescribe this heavy medication,” he said in an interview. “But when they come to me, I have no choice. I have to help this family, this mother. I have no choice.”

Ms. Warren conceded that she resorted to medicating Kyle because she was unprepared for parenthood at age 22, living in difficult circumstances, sometimes distracted. “It was complicated,” she said. “Very tense.”

I don't want to get all moralistic about this. From the story it sounds like Kyle was a little terror, and kids like him used to get beaten a lot and locked in closets or woodsheds. Maybe Risperdal is a step up in civilization from that. I dislike the "all he needed was more love and attention from a mother who had more control of her own life" tone that the article exudes. The story is a powerful argument for not having children until you are older and have more money, but that isn't the situation of a lot of mothers and stern lectures from conservative doctors aren't necessarily going to help them. Some kids really are troubled, and if adults can be helped by psychiatric medications, I don't see why kids can't be.

What I find disturbing is the cavalier way this is being done in America. Antipsychotics should not be prescribed until the patient has had a full psychiatric evaluation, and according to Wilson that has not been done for 40% of the preschool children on these medications. The picture I get is one of overwhelmed single mothers or poor couples working too many jobs who can't deal with their problem children and have nowhere to turn for help but to doctors who don't have time to do much besides write a prescription. That is a symptom of a screwed up society, not just a problem with over-medication. National health insurance, anyone? It strikes me that home nursing visits might help some of these mothers a lot. What seems to have helped Kyle and his mother was an "early childhood support program" for families with troubled preschool children; in other words, exactly the sort of program states are cutting back or eliminating to balance their budgets. Drugs are being used as a cheap substitute for real health care and real help for families, and that helps no one.