One of my favorite topics here at World of Psychology is pointing out the poor choices we make when faced with very little knowledge. You’d think human beings, when faced with a lack of data, would choose not to do anything in order to protect themselves or their loved ones. Especially when those loved ones are our own children.
Psychologists have known, for instance, based upon real data and science compiled over the past 8 or 9 decades, that children are not just miniature versions of adults. Any physician or pediatrician also knows and understands this to be true — it’s not even a question open for debate.
Yet those same physicians and pediatricians and psychiatrists will not blink an eye at prescribing adult medications to children — medications on which we have very little data or evidence that they work in the same way, with little or no long-term developmental side effects. You know, those pesky little things like lowering intelligence, causing other behavioral or social problems, or causing physical damage to the developing brain or other body parts.
The number of child psychiatric medications which have undergone the same rigorous FDA approval processes as the adult versions is relatively small — mostly medications for ADHD, a fairly common childhood affliction. Some have also been approved for children’s use for depression and bipolar disorder, as well as some other mostly childhood-based mental disorders.
This process has been going on for so long, however, that most doctors see nothing wrong with it. This article describes the simplicity of the method of prescribing psychiatric medications (whether approved for children’s use or not):
Although much of the initial information regarding psychiatric medication use comes from adult studies, child and adolescent psychiatrists may consider trying them in younger age groups and encourage future approval for children. This process can begin when professionals describe their successes in single cases.
In other words, some enterprising doctors see the potential for a peer-reviewed journal publication and think nothing of using a child as a guinea pig to help forward our understanding and knowledge. You know, it’s all “in the name of science.” Does the informed consent procedure in such cases include the statement, “We have no idea what the long-term developmental side effects of prescribing this medication to your child over the course of 3 or 4 or 5 years may be. Your child could suffer from significant side effects 10 or 20 years from now, we just don’t know”?
No, it doesn’t, at least not in so many words.
Why have we gotten where we are today, with so many studies looking at the safety and efficacy of drugs for adults and so few for children? The Washington Post has an article today that describes exactly that — A Gap in Knowledge About Kids, Medication. Well worth the read.
A few weeks ago, Los Angeles Times asked the question a lot more of us are asking these days, Are we too quick to medicate children? I’m not sure if the answer is an unqualified “Yes,” but I do know the current state of affairs leaves me scared to death we are prescribing sometimes very powerful, unapproved-for-children’s-use drugs without really understanding the potential harm they may bring to the child in the future.
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Dr. Grohol, Nurses for Human Rights supports your viewpoint and opinion and feel that this issue has not been given enough importance to our legislators. We feel this violates the provisions in Human Rights regarding experimentation and our Nurses Code of Ethics regarding Informed Consent for parents.
What kind of Psychology do you practice? Are you suggesting that children who suffer from profound depression should simply suffer? I agree that we should be very careful when medicating children, but medications are needed for the few that are suffering tremendously. Testing on children is controversial but is needed. Question: willyou offer up your own child for that?
Children metabolize these drugs faster, so the dosage administered isn’t always the measuring stick when talking about the issue. A child who is halluicinating from psychosis brought on by abuse may need a smal dose of Abilify (1-2 mg) until the crisis abates and the therapy can begin to work. Otherwise, you have an aggressive child who will simply be admitted to the hospital and eventually get the drugs anyway. Let’s please stop lying to ourselves and these families.
You need to re-read what I wrote, because nowhere in my entry did I suggest that medication that has been FDA-approved for children’s use shouldn’t be prescribed.
I’d say let’s stop lying to ourselves if we’re not going to follow the procedures that we, as a society in the U.S., put into place to ensure the safety and efficacy of drugs. Just because a drug is safe and effective for adults doesn’t mean it is for children — read the real-world examples given in the Post article.
So yes, we have to be “very careful when medication children” and “medications are needed for the few that are suffering tremdendously.” But we also have to put our children’s health and safety first, and that means following the rules we ourselves follow for drugs in adults — ensuring the FDA has approved their use in children before being widely prescribed.
If we don’t like the process, then we should change the process. Right now we’re simply giving lip service to the process if docs are just ignoring FDA guidelines and doing whatever they “feel” is right…
So what’s the answer? Just not medicate kids?
It’s entirely true that they’re not little adults. Kids with mental illnesses tend to be much worse off than people who develop mental illness only in adulthood, for example.
We don’t know all the effects of medications for children. Researchers are reluctant to test medications on children and review boards are reluctant to let them. If we want rigorously-tested medications for kids, we have to advocate for the politically unpopular notion of testing medications in kids. (This is a similar issue to medications for pregnant women – it’s extremely important, yet avoided due to fear of lawsuits and censure.)
Adults have a power to advocate for themselves that children lack. We know that there’s not much that could be worse than our untreated mental illness. And so we seek professional help through medication and therapy – help that is far more readily available for adults than for children.
I had my first experience with depression at age 12. I knew quite well in high school that the reason my mother got Prozac and I didn’t was that she was an adult, and adults’ problems get taken seriously – and responded to – in a way that kids’ problems don’t, even when equivalently severe (or in my case considerably more so).
In a way, I was “lucky” – I got treatment in the form of ineffective talk therapy. I went faithfully to my therapist every week while I spiraled down into suicidal depression.
At 19 I went to my university counseling center and was prescribed medication, and found out for the first time how amazing it is to be simply, quietly, normal.
I wish that option had been available to me seven or eight years earlier – if I’d been adequately treated, I could have spent so much more time developing relationships, working hard, and contributing to the world…and not being in pain. I might even have been able to avoid several major depressive episodes and two hospitalizations.
That’s changing some now, thank god. In some venues, children’s pain is being taken seriously. More power to everyone who does so.
As adults, we are responsible for advocating for children, absolutely. And a part of the advocation, in my book anyway, is to first, “do no harm.”
We as a society have chosen to have a certain standard for testing the safety and efficacy of drugs in adults. Why not hold that same standard to children, who are more vulnerable? Who need adults’ protection from people or companies looking to “expand a market.”
Seriously, if we think it’s okay that we don’t do rigorous testing on medicines, that’s fine — let’s disband the FDA tomorrow and make it equal across the board. But let’s not set one, high standard for adults, and then a lower (or no) standard for children because the research is “harder.”
Worse case scenario? 10 or 20 years from now we find all the children prescribed a class of meds (like atypical antipsychotics) suffer from a higher incidence of brain tumors, cancer, or some other malady. Or perhaps it’ll be more subtle, such as a lower IQ or memory problems in mid-life… Without the research, we just don’t know.