Medication & ADHD or Biploar Diagnoses in Children
The PBS show Frontline recently aired a show on the Medicated Child (http://www.pbs.org/wgbh/pages/frontline/medicatedchild/). The focus was on children medicated for AD/HD and bipolar disorder. In interviews with parents and physicians, the show looked at the increasing tendency to medicate even young children for behavior-related disorders.
A question often arises about whether there really are so many more children who have attention deficit/hyperactive disorder (AD/HD) or whether this diagnosis is being used for controlling the exuberant child or the child who does not conform to adult expectations for behavior. The show also told about a recent trend positing that many cases of AD/HD are really bipolar disorder. We know that children are not mini-adults and that their symptoms sometimes differ from those of adults. This theory suggests that bipolar disorder in children manifests as AD/HD. For those who subscribe to this theory, medication of children with medications for bipolar disorder has become more prevalent. Yet, these drugs have not been approved for use with children nor have they been tested for effectiveness or safety on children.
Any diagnosis of bi-polar for a child, especially if medication is recommended should be reviewed by a child psychiatrist as bi-polar disorder is considered very unusual below adolescence. A diagnosis of AD/HD in young children usually depends on descriptions of the symptoms/behaviors and the absence of symptoms for other disorders that appear similar. Usually a clinician would want to know whether the symptoms/behaviors occur in at least 2-3 different settings. If the diagnosis is correct, stimulant medication trials usually result in significant behavioral changes quickly. Over the past 20 years, the prevalence rate of AD/HD has not changed much (4-7%). However, a higher rate in a community might call for an assessment of the quality of the diagnosis, and asking for second opinions.
Where do schools fit into all of this? When it comes to medicating children for behavioral problems, parents ultimately make the decisions. Sometimes teachers have insisted that parents medicate their children because their behavior is so disruptive that the teachers cannot handle them. That is not an appropriate role for a school. However, teachers could refer children to a school psychologist, counselor, social worker, or nurse for assessment. Such school support services personnel could work with the parents and teacher(s) to develop a plan that all agree with. If the child is in special education, that might be an individualized education plan (IEP). However, not all children with behavioral issues received special education services. Consistency of behavioral expectations between home and school are important for children with behavioral problems – whether they are mediated or not.
When there is a plan, schools have a role in implementing their part of the plan and monitoring the students’ behaviors. Keeping lines of communication open with parents and health care providers can contribute to knowledge about what works and does not work. School nurses should not only administer medications during the school day but monitor reactions to the medications and report any adverse effects. School nurses might also notice if the prevalence of the diagnosis seems too high in the community.
Knowledge about brain chemistry and development is in its infancy. Undoubtedly there are children whose developing brains do not function normally and how might benefit from medication. For now, making the decisions about who needs medication and which medications is more an art than a science, especially in behavioral health.
What is your experience with medicating or not medicating children for behavioral problems?
