I remain astounded that psychiatrists and pediatricians think it’s occasionally appropriate to prescribe adult atypical antipsychotic medications — like Risperdal — to children younger than age 5.
Last week, The New York Times covered the story of Kyle Warren, a boy who began risperidone (Risperdal) treatment at age 2. Yes, you read the right — age 2.
He was rescued from this unbelievable prescription by Dr. Mary Margaret Gleason through a treatment effort called the Early Childhood Supporters and Services program in Louisiana. Dr. Gleason helped wean young Kyle off of the medications from ages 3 to 5, and helped understand that Kyle’s tantrums came from his stressful and upsetting family situation — not a brain disorder, bipolar disorder, or autism.
Imagine that — a child responding to a family situation that is stressful and involves his two primary role models — his parents.
After carefully reviewing the limited amount of research in this area, Psych Central recommends that parents should never accept an atypical antipsychotic medication prescription for a child age 5 or younger. If your doctor makes such a prescription, you should (a) look for another doctor and (b) consider filing a complaint with your state’s medical board against the doctor.
There is an astonishing lack of empirical or clinical data that suggest prescribing these kinds of medications to such young children — age 5 or younger — results in any significant change in mood or behavior. Lacking such data, it our opinion that it is simply irresponsible and inappropriate for medical professionals to prescribe such medications to young children.
There have been virtually no longitudinal studies conducted on children younger than 13 on these medications. We have no idea what the long-term effects of prescribing risperdal to a 2-year-old has on their long term cognitive and personality development. What few studies have been conducted and use the term “longitudinal” measure results and side effects at time periods like 6 months or 12 months (the maximum time of study we could find in a literature search). Yet few children are prescribed these kinds of medications for only 6 or 12 months. There’s continues to be a serious disconnect between how medications are prescribed in practice, and how they are researched.
The amount and number of tiny studies done on young children — those younger than 13 — for most of these medications is equally heart-stopping. They are few and far between, with typically small sample sizes (often in the 20 to 30 person range).
What brought this on was a recent article in The New York Times about a 3-year-old who was on an atypical antipsychotic. He was eventually diagnosed as simply having attention deficit disorder later on, but who knows what damage was done by the medication to his young, developing brain in the meantime.
It’s time to put a stop to this out-of-control prescription of atypical antipsychotics off-label. The American Academic of Child and Adolescent Psychiatry apparently agrees:
Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry, concerned about the lack of research, has recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years. “Psychotherapy is the key to the treatment of preschool children with severe mental disorders, and antipsychotics are adjunctive therapy — not the other way around,” he said.
So why do doctors continue to prescribe clearly inappropriate medications to younger and younger children? Costs and time. Medication is cheaper than psychotherapy in most cases. And psychotherapeutic interventions require a time and commitment on the family’s part to embrace change. Changing the family dynamics, changing the nature and quality of the parenting relationships, and changing how a parent copes with stress and the behavior of their child. Many parents fear a therapist will also be more judgmental — telling them that their parenting styles may have led to the child’s current problematic behavior. Some parents just aren’t able to hear that (even if therapists are usually far more tactful than looking to place blame — therapy is about helping produce beneficial changes, not blame).
But it is cheaper to medicate children than to pay for family counseling, a fact highlighted by a Rutgers University study last year that found children from low-income families, like Kyle, were four times as likely as the privately insured to receive antipsychotic medicines.
Texas Medicaid data obtained by The New York Times showed a record $96 million was spent last year on antipsychotic drugs for teenagers and children — including three unidentified infants who were given the drugs before their first birthdays.
In addition, foster care children seem to be medicated more often, prompting a Senate panel in June to ask the Government Accountability Office to investigate such practices.
In the last few years, doctors’ concerns have led some states, like Florida and California, to put in place restrictions on doctors who want to prescribe antipsychotics for young children, requiring a second opinion or prior approval, especially for those on Medicaid. Some states now report that prescriptions are declining as a result.
A study released in July by 16 state Medicaid medical directors, which once had the working title “Too Many, Too Much, Too Young,” recommended that more states require second opinions, outside consultation or other methods to assure proper prescriptions.
In a followup to the main article, Dr. Gleason responds to some readers’ questions, in an article entitled A Child Psychiatrist Responds. She confirms our reading of the research:
There is no scientific support for the use of psychiatric medications in infants and toddlers and limited support in preschoolers. However, parents know better than anyone else that there few available resources for families worried about their young child’s emotional or behavioral well being.
While the latter may be true, that’s little excuse for what’s happening with these kinds of crazy young prescriptions. Doctors, of course, should know better. But parents too have a responsibility to read up and become educated about the treatments a doctor is recommending for their toddler or preschooler.
The program Dr. Gleason is associated with sounds ideal — I wish we could replicate it across the country:
In our program, we also do consider the role of medication as part of the treatment plan in older preschoolers whose severe symptoms persist after therapy and who have a diagnosis that has been shown to respond to medications. We try to use all available research to guide these considerations. It is important in psychiatry — just like in other medical specialties — that we make treatment recommendations based on careful assessment and understanding of the child’s symptoms, relationships and life stressors. We also need to track how treatment is working and stop medications that are not improving a child’s functioning or are causing side effects that interfere with the child’s optimal functioning. Our goal is to help children and families enjoy each other, function at the highest level they can, and maintain physical health.
In my mind, a treatment approach that uses comprehensive assessment, and considers biological, psychological, and social factors in the patient’s life and uses treatments supported by the strongest evidence is far from anti-psychiatry. It is the best kind of psychiatry we can offer.
I understand the problems parents face when dealing with an out-of-control 2 year old. But the answer is not an atypical antipsychotic medication. The answer lies in gaining better parenting skills, and getting the child into a child psychologist or other early intervention child care program that understands the value of examining a family’s dynamics to get the whole story.
Because a 2 or 3-year-old should never be prescribed an atypical antipsychotic psychiatric medication.
Read the original article about Kyle and his family’s ordeal: Child’s Ordeal Shows Dangers of Antipsychotic Drugs
13 comments
Take this post and bring it to the doorsteps of the alleged KOLs in C & A psychiatry, I know of one in particular in Massachusetts, and when they open the door, read it, and then try to rationalize, minimize, and validate the reasons to continue such inappropriate behaviors, well, just don’t carry lethal weapons on you during the discussion.
Oh, I forgot, the doctor will have one. His Rx pad!!!
Written by a psychiatrist!
I really hope this family filed a malpractice suit against this doctor. Not appropriate at all. If he really really felt that drugs were necessary he should’ve referred the family to a child psychiatrist.
Also, if the parent does not have time for therapy when their preschooler is out of control, then they frankly shouldn’t have had (another) child. Now if they don’t have the money or access or logistics to make family therapy happen, then that’s another matter that I hope we are working on fixing.
Dr. Grohol writes, “The answer lies in gaining better parenting skills, and getting the child into a child psychologist or other early intervention child care program that understands the value of examining a family’s dynamics to get the whole story.”
That’s it in a nutshell. Anyone who prescribes antipsychotics to toddlers and preschoolers should be required to work 8 hours a day in a room full of them for at least a year, before being allowed to hand out the first script. I worked for a year in a room full of 2 year olds, and I know for a fact that sanity in young children is nonexistent. They haven’t learned to be sane yet. Rapid cycling? Check. Delusional? Check. Fits of anger? Check. Physical violence against self and others? Check. Banging their heads, throwing themselves in the floor, pinching each other, clocking each other in the head, screaming, crying, you name it I saw it. Daily. 10 minutes later they’re just as happy and sweet as can be.
My nieces when they were that age would hit themselves and bang their heads when they got frustrated. I even remember one of them around age 2 pulling my sister’s hair when she was angry. With consistent, firm, loving parents they gradually gained more self control – without drugs. They’re happy well adjusted children today.
I have no doubt that had they been taken to a child psychiatrist who commonly prescribes to that age group that they would have been medicated. Frightening.
One issue consistently overlooked by these “oh no we’re overmedicating our children” articles is the fact that child psychiatry is the single most underserved medical specialty there is. Over 85% of child psych prescriptions are written by non-child-psychiatrists, as there are huge waiting lists to see these specialists, if you can even find one that takes your insurance (if you have insurance). Access to therapy, and patient willingness to engage in therapy, are also major barriers that drive overuse of meds. These articles create the impression that child psychiatry as a field condones inappropriate medication of children, which is simply not the case.
Evilrobot, I don’t doubt you’re right about most of the scripts being written by those who aren’t child psychiatrists. However, I would be interested to know what percentage of children who do see a child psychiatrist leave without a script. I would imagine that percentage is very small. It would be interesting to know, however. Regardless of who is doing the prescribing of antipsychotics to children, it’s sad for the children and their developing brains.
Technically, no one has been able to provide any empirical evidence that mental illness even exists as a chemical imbalance. With the exception of physical damage, like mercury poisoning, of course.
What happens when you take steroids? Your body stops producing it’s own. If you take melatonin at night, it’s benefit declines with use because your body stops producing as much.
Look at anyone – child or adult – on any medication of any kind taken long term and their bodies adapt to it as the body attempts to return to it’s own natural balance.
Like the taking of steroids, there is danger in long term use of any medication regardless of age. Antidepressants are labeled with the side effect “may cause thoughts of suicide” but not because the medication itself causes it. Because taking antidepressants long term causes the hypothalamus to decrease in size which has been shown to cause a decrease in self esteem which, naturally makes issues of depression worse and requires a greater dependence on drugs.
In my opinion, these drugs all have value. In moderation. But people need to stop looking at children and adults as machines to be manipulated. Use the drugs in emergency situations but never use long term.
On all this I speak from experience. I was on drugs between the ages of 8 and 18. When I finally took myself off the drugs about 10 years ago I was able to prove that I didn’t have any problems at all. I just grew up in an abusive household. It took me 10 years after taking myself off the drugs to recover from the chemical damage. Even 8 years old is too young.
Joseph Biederman is THE most cited psychiatrist responsible for prescriptions for “juveniles” (preschool aged.)
He uses his post at Harvard to do it.
Elliander-
You need to look at the research again. First of all, the small increased risk of new suicidal thoughts or actions is only during the first few months of the medication. Once a person is stable on the antidepressant, that’s not really a risk. They actually have a lower chance of suicide then someone with untreated Major depression. Furthermore, suicidal thoughts is a common symptom of Major Depression; so it’s difficult to tell if it’s really the antidepressant or the natural progression of the disorder.
Also, the research shows that antidepressants (and therapy) cause the hippocampus to increase in size over time and research has shown that antidepressants even stimulant new neurons to be formed.
As far as long terms use of psych drugs by children or otherwise, I agree that’s not an ideal situation and the length of treatment should be determined on a case by case basis, preferably by a psychiatrist and a therapist.
LS
Some people who were NOT suicidal before taking ssri’s experience compulsive suicidal ideation (and some carry it out).
Increases in suicidal ideation and suicide itself have been PROVEN IN CLINICAL TRIALS.
Help my two year old grandson who saw this doctor in one office visit was given risperidone for throwing tantrums. I am totally against this and very worried for my grandson. what can I do?
So. A toddler doesnt have autism that leads to severe anxiety, aggression, major meltdowns, & very violent behaviour resulting in harming himself & siblings: no,of course, it’s the parent’s fault. It’s their “lack of parenting skills”. Or that the parent doesnt have money or even time to engage in therapy for their beloved child. Or, that’s right, it’s the family & social dynamics. Of course it is. It doesnt matter that the parent may be a social worker whose expertise is in child & family therapy; or that the parent may be a child psychologist… it’s still the parent’s fault isnt it. It’s always the parent’s fault. Neurodiversity and associated behaviours result from lack of parenting skills. Uh ha.
Anyone who has an autistic child with severely aggressive & violent behaviours will know that it is bloody NOT a parent’s fault. Parents give up their jobs, social lives, everything- to be more available to their child; to support them fully with early interventions, therapies, paediatrician appoints, special needs ducational programs… spend as much money as necessary and give every second to support their child- but, you said it, it’s the parent’s fault. Its just lack of parenting skills. I bet none of the people who have commented have autistic children with these behaviours. Your comments are ignorant and iffensive. I am really angry.
No, i dont believe long-term use of medication is the ideal answer, of course not, but neither is it a parent’s fault. Ignorant, daft, hurtful people (& haha, i had to laugh at the person who thinks they can comment on special needs kids, because she worked in a child care centre).
Do some proper research with parents & their children- then try saying that it’s just a lack of parenting skill.
SO extremely offensive & ignorant.
I am from Canada and recently CBC Go Public is representing a mother whose 4 year old son was prescribed an antipsychotic medicaton. The story is that the Shoppers Drug Mart pharmacy mistakenly gave ten times the dosage in a prescription. No one has asked why a four year old boy was given an antipsychotic for behavioural problems, nor why the mother waited four months to realize that her son was drooling and falling and behaving like he was drunk due to the mistake. I am outraged that no one is questioning either the mother or the doctor in this incident. Thank goodness someone has the good sense to see that our children are being overmedicated, and probably due to poor parenting skills, as in my experience all healthy four year old boys are very very active, and do not need to be medicated so their parents can cope.
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