Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Wednesday, February 9, 2011

Proposed Ban on Antipsychotic Use in Children Five and Under

A study published in February issue of the Archives of General Psychiatry, written by Nancy Andreasen, former editor-in-chief of the American Journal of Psychiatry, provides evidence that long term use of antipsychotic medication results in loss of brain volume. She concludes that
Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.
I propose that based on these findings, there be a ban on use of antipsychotic medication in children age five and under, the period of time when the brain is undergoing the most rapid growth and development.I specify this age group not only because they are the most vulnerable, but also because beyond age six the brain is less plastic, and so alternative interventions that aim to change the structure of the brain may be less effective. Also, it is a reasonable goal. If more evidence about damaging effects emerges it may be necessary to extend the ban to all children.

Those who advocate for use of antipsychotics in young children with a range of behavior problems argue that stress hurts the brain and that these medications can protect the brain from this stress. When children and parents feel out of control, when there is sleep deprivation and explosive behavior, both parents and children experience a great deal of stress. It is not surprising that giving a powerful drug that acts on the brain would calm a child down.

Medication, however, is not the only way to reduce stress. Being understood by people who love you also reduces stress at the level of brain biochemistry. Reducing stress and changing the brain in this way is not easy. It requires sustained effort and a lot of support for parents. But the changes are safe, and may last a lifetime.

The growing field of parent-infant mental health offers quality research and a wealth of effective interventions to support troubled children and their parents.These interventions , unfortunately, are not well covered by third party payers and are not marketed as widely as prescription drugs. , They require hard work and do not offer the “quick fix” of medication. As such, they are less available for struggling children and families.

As long as a drug is available (and the preferred mode of treatment according to the health insurance industry), motivation to do this more difficult work will be lost. In addition, there is a severe shortage of quality mental health care services. This is due to many factors, including poor reimbursement and prohibitively complex administrative costs for private practitioners. Just as motivation may be lost on an individual level, as long as the drug is available, there is little motivation to change the health care system to more effectively provide these alternative interventions.

All of this is reason enough not to use these medications in very young children. Add to this the solid evidence that these drugs damage the brains of adults, and using them in children whose brains are rapidly growing is, in my opinion, unconscionable.

3 comments:

  1. Well said. Now if we could only provide adequate help to those families desperate to control/change maladaptive behavior not only via funding for infant/mental health work but for things like aba for children with autism or mental retardation.
    Dr_som
    Pensivepediatrician.com

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  2. What about a six year-old? Can these drugs be just as detrimental to his development???

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  3. ADHD amphetamines also cause brain shrinkage and deterioration and SSRIs have several side effects including the increase in violence and suicide.

    There's no real evidence that mental disorders are cause by a chemical imbalance but we certainly understand that added these PhRMA chemicals can cause damage.

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