PSYCHIATRIC TREATMENT OF CHILDREN & ADOLESCENTS

Experts claim that approximately 20% of children in the U.S. have mental disorders with some functional impairment, including about 5-9% of children and adolescents between the ages of 9 and 17 who are defined by federal regulations as having "serious emotional disturbance" (Friedman et al., 1996b). "Serious emotional disturbance" (SED) refers to children under age 18 with a diagnosable mental health problem that disrupts their ability to function.  SED is not a diagnosis, but rather a catchall legal term entitling a child so designated to a host of government-mandated services.

Trends in the prescribing of psychotropic medications to preschoolers.
Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F.
JAMA 2000 Feb 23;283(8):1025-30.

The results of this study indicate that between 1990 and 1995, the number of children aged 2 through 4 taking psychotropic drugs increased by 50%, from 100,000 to 150,000. In particular, prescriptions rates for stimulant drugs, for antidepressant drugs -particularly tricyclic antidepressants- and for clonidine, an alpha 2-agonist that suppresses central nervous system function and is used to treat insomnia- increased by 3-, 2-, and 28-folds, respectively. The article also reports that, according to data released by the FDA, in 1994 doctors wrote 3,000 prescriptions for Prozac in children younger than 1 year. The large increase in intake of drugs that interfere with the developing brain is worrisome, particularly when considering that no data exist on their safety and efficacy, and that these drugs are used off-label, i.e. their use has not been approved in children younger than 6.

Behavioural disorders are overdiagnosed in US.
Roberts, J.
BMJ 1996;312:657 (16 March).

This article reports on the United Nations' and the US Drug Enforcement Administration' concerns about the widespread use of the amphetamine Ritalin to control children behavior. It is emphasized that the worldwide production of Ritalin almost trebled from 1990 to 1994, with 90% of the product being prescribed to American children, adolescents and adults. Statistics elaborated by the United Nations revealed that in 1995 more than 2 millions children and 10-12% of American boys (attention-deficit disorder is diagnosed 4 times more frequently in boys than in girls) where taking the drug. The concern is that children may be improperly diagnosed and treated as shown by research conducted in 1994 at the University of California-Riverside, indicating that 50% of children diagnosed with attention deficit disorder are prescribed the drug without undergoing psychological or educational testing.

US education board advises against drugs for behavioural problems. News.
Charatan F.
BMJ 1999;319:1456 ( 4 December ).

This article reports on a resolution passed by the Colorado Board of Education urging teachers to employ educational measures to control children's disruptive behavior rather than counseling parents to seek drug treatment for their children. Members of the Board were especially concerned about the finding that many violent crimes occurring in schools are committed by students who are taking anti-psychotic drugs (as an example, Eric Harris, one of the author of the massacre of Columbine High School in Littleton, Colorado, had been taking the antidepressant fluvoxamine). Dr. Peter Bregging, director of the International Centre for Study of Psychiatry and Psychology in Bethesda, Maryland, also believes that psychotropic drug use in children is linked to violence. Currently in the U.S., approximately 2.5 million children are prescribed drugs for attention-deficit disorder.

Tardive dyskinesia and other clinical consequences of neuroleptic treatment in children and adolescents.
Gualtieri CT, et al.
Am J Psychiatry 1984 Jan;141(1):20-3.

The results of this study show that 18 of 41 children, adolescents, and young adults in whom discontinuation of chronic neuroleptic drug treatment was attempted, developed withdrawal symptoms such as tardive dyskinesia movement disorders and behavior deterioration. In only 12 individuals antipsychotic drug treatment had to be restarted, indicating that discontinuation of treatment should always be tried even in chronically medicated patients.

Neuroleptic use, parkinsonian symptoms, tardive dyskinesia, and associated factors in child and adolescent psychiatric patients.
Richardson MA, et al.
Am J Psychiatry 1991 Oct;148(10):1322-8.

This study evaluated the rate of occurrence of drug-induced parkinsonism and tardive dyskinesia in a cohort of 104 children and adolescents treated with antipsychotic drugs in a psychiatric hospital. Of the 104 children, 61 were found to have risk factors for the development of parkinsonism and 41 had risk factors for the development of tardive dyskinesia. Of the children with risk factors, 34% developed parkinsonism and 12% tardive dyskinesia. These data indicate a high rate of severe and disabling complications in neuroleptic-treated children and adolescents, indicating that these drugs should be given only when absolutely necessary and for the shortest period of time.

Adolescents on neuroleptic medication: is this population at risk for tardive dyskinesia?
McDermid SA, et al.
Can J Psychiatry 1998 Aug;43(6):629-31.

The results of this study, conducted on a cohort of 40 adolescents treated with antipsychotic drugs, show that over a two-year period, 5% of them developed full-blown tardive diskinesia and an additional 12.5% developed symptoms of tardive diskinesia, indicating that, contrary to common thinking, the risk of this severe and disabling complication is high in every age group.

Increased methylphenidate usage for attention deficit disorder in the 1990s. Safer DJ, Zito JM, Fine EM.
Pediatrics 1996 Dec;98(6 Pt 1):1084-8.

The results of this study indicate that from 1990 to 1995, rates of prescription of the psychostimulant drug Ritalin (methylphenidate ) for attention-deficit disorder increased by 2.5-folds, and in 1995, approximately 3% (or 1.5 million) of U.S. youths aged 5 to 18 years were taking the drug.

Antidepressant prescribing practices of outpatient psychiatrists.
Olfson M. et al.
Arch Gen Psychiatry 1998 Apr;55(4):310-6.

The results of this study show that, from 1985 to 1994, the proportion of outpatient psychiatric visits resulting in prescription of an antidepressant drug increased from 23% to 49%. Patients were 2.3 times more likely to receive a prescription in 1994 compared to 1985. Rates of prescribing increased particularly for children and young adolescents, and for individuals with less severe psychiatric disorders.

Psychotropic medication treatment patterns among school-aged children in foster care.
Zima BT, Bussing R, Crecelius GM, Kaufman A, Belin TR.
J Child Adolesc Psychopharmacol 1999;9(3):135-47.

The results of this study indicate that 16% of children who live in foster homes for at least 6 months receive psychotropic drugs.

Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment.
Connor DF. et al.
J Child Adolesc Psychopharmacol, 8(1):27-38 1998.

The results of this study, conducted on a cohort of 83 emotionally disturbed children and adolescents admitted to a residential treatment facility, show that 76% of them were started on psychotropic drugs. Antipsychotic drugs, sedative-hypnotics and antiepileptics were given to 35%, 26%, and 15% of individuals, respectively. Forty percent of youths received a minimum of two psychotropic drugs.

Use our to find a doctor in your area.