A study reported in the December 14 edition of Pediatrics found that nearly 15 percent of a group of more than 3,000 children ages 8 to 15 met the criteria for a diagnosis of generalized anxiety disorder, panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) or conduct disorder.
In clinical settings today, children with mental or behavioral disorders are being prescribed psychotropic medications at increasingly early ages. Psychotropic medications affect brain chemicals related to mood and behavior. This drug class includes the following types of medications:
- Antidepressants, such as Prozac (fluoxetine) and Elavil (amitriptyline)
- Antipsychotics, such as Abilify (aripiprazole) and Thorazine (chlorpromazine)
- Mood stabilizers, such as Depakene (valproic acid) and lithium
- Anti-anxiety agents, such as Valium (diazepam) and Xanax (alprazolam)
- Stimulants, such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine)
Although designed for and tested on adults, these medications are increasingly being prescribed to children diagnosed with mental health issues, even though little evidence exists about their effects on growing, maturing brains and bodies. In recent years, researchers have conducted more trials and studies to better understand the benefits and risks of using psychotropics in children. However, more information is needed about the effects of psychotropics, especially in children younger than 6.
Some children need medication to manage severe and difficult problems. Without treatment, these children could suffer serious or dangerous consequences. In addition, talk therapy and other psychosocial treatments may not be effective by themselves. In some instances, however, they can be quite effective when combined with medication.
Medications Affect Children Differently
Parents and health care providers need to remember that children handle medications differently than adults and even teens. Studies have found that developing brains can be very sensitive to medications, plus there are developmental differences in how children's bodies process, or metabolize, drugs. Therefore, doctors should carefully consider the dosage or how much medication to give each child.
Also, avoiding drug interactions is important for safeguarding a child's health. If a child undergoing treatment for a mental health issue also takes prescription or nonprescription medicine for asthma or another health problem, her or his doctor and pharmacist need to know which drugs so they can make sure any psychotropic prescribed will not react badly with other medications. Drug interactions can cause medications to not work as intended or lead to serious side effects.
While society has come to accept the idea that popping a pill is the first line of treatment for many physical and mental health issues, psychotropic medication should not be the only treatment a child receives. Other services should be included in a child's treatment plan, such as psychological therapy, family support services, educational classes and behavior management techniques.
If a child is prescribed a psychotropic medication, he or she should be evaluated by the prescribing health care provider regularly to make sure the medication is working and is still appropriate. Children need treatment plans tailored to their individual problems and needs.
The dosage of a psychotropic medications a child is prescribed depends on that child's weight and age. The National Institutes for Mental Health has published a medications booklet that describes the types of psychotropic medications available and includes a chart that lists the ages for which each medication is FDA-approved. The FDA's Web site also offers the latest information on medication approvals and warnings, along with patient information guides.
Children and Medication Safety
When the FDA approves a medication, it means the drugmaker provided the agency with data showing the medication is safe and effective for a particular group of people. Based on this information, the drug's label lists proper dosage, potential side effects and approved ages. Medications approved for children follow these guidelines.
Many psychotropic medications, a noted earlier, have not been studied in children, which means they have not been approved by the FDA for children. Nevertheless, doctors may prescribe medications as they feel appropriate, even if those uses are not included on the label. This is called off-label use. Research shows off-label use of some medications works well in some children, and other medications need more study in children. In particular, the use of most psychotropic medications has not been adequately studied in preschoolers.
More studies in children are needed before health care providers can fully know the appropriate dosages, how a medication works in children and what effects a medication might have on learning and development. However, getting that testing performed faces some hurdles.
In the past, psychotropic medications were seldom studied in children because mental illness was not recognized in childhood. Also, there were and continue to be ethical concerns about involving children in research. The FDA has been urging that medications be appropriately studied in children, and Congress passed legislation in 1997 offering incentives to drug manufacturers to carry out such testing. These activities have helped increase research on the effects of medications in children.
The Congressional incentives, however, have not solved the ethical dilemmas about testing medications in children. Strict rules protect young participants in drug trials, and each study must go through many types of reviews before and after it begins. These measures, though, cannot remove the possibility that a promising drug candidate undergoing testing could irreparably harm a child, whose consent to being a guinea pig is given by parental proxy and who cannot fully comprehend and appreciate the risks inherent in medical testing.
Any parent or guardian of a child prescribed a psychotropic medication should ask the prescribing health care provider about the risks of starting and continuing the medication. Parents and guardians of children undergoing psychotropic medication therapy should learn everything they can about the medications prescribed to their children, including their possible side effects and what a particular medication is supposed to do (for example, is the medication supposed to address a specific behavior). That way, if the child does not appear to be getting the benefit she or he should be getting from a medication, the parent can discuss the issue with the prescribing doctor.
Additionally, parents and guardians need to discuss with the prescriber how long a medication needs to be taken before it begins to take effect: Some drugs must be taken up to eight weeks before they begin to impact the person taking them. Parents and guardians also should know the risks of stopping a child's medication. While the answers to some of these questions can seem frightening, parents must keep in mind that serious mental disorders can harm brain development untreated.
While researchers are trying to clarify how early treatment affects a growing body, families and doctors should weigh the benefits and risks of medication therapy for a child diagnosed with a mental health disorder. Each child has individual needs, and each child needs to be monitored closely while taking medications.