The Use of Medications in Children for Treatment of Mental Illness
January 10th, 2011 
Carol 
According to the National Institute of Mental Health (NIMH), about 2 in 10 children in the U.S. suffer mental illness severe enough to cause impairment. In particular, the drastic increase in suicide between the ages of 5 and14 has raised significant concerns. There is not enough research to determine exactly why mental illness among youth is on the rise, but the use of interventions to prevent further increase is crucial.
Evidenced-Based Interventions (EBI) require clinicians to improve care by using the most current evidence and research to make decisions about treatment on an individualized basis. This includes both therapy and medication management if necessary. However, within the last 15 years, the prevalence of psychotropic medication treatment for children and adolescents with mental illness (e.g. emotional and behavioral disorders) has significantly increased without proven research on the developmental impacts of taking it. The National Alliance of Mental Illness (NAMI) clearly states, “Psychotropic medications for young children should be used only when anticipated benefits outweigh the risks.”
I worked with several 4- and 5-year-old patients admitted to inpatient and partial hospital programs with multiple diagnoses coming from pediatricians. In addition, they are often prescribed psychotropic medications and sometimes more than one. For example, how often do you hear and see children labeled as ADHD (Attention Deficit Hyperactivity Disorder)? ADHD is considered a neurobiological disorder including a dysregulation of the neurotransmitters dopamine and norepinephrine in the frontal lobes. A thorough evaluation is necessary to determine this diagnosis. Many professionals use the Connor’s Rating Scale or the ADHD problem checklist. One of the DSM-IV criterion requires the patient to demonstrate symptoms and behaviors in more than one setting. Other factors to consider are genetics and rule outs of other Axis I or II conditions, where a strong family history is common. It is important to recognize that hyperactivity and defiance are also normal childhood behaviors; hence formulating an accurate diagnosis for mental illness can be difficult. Medication should only be prescribed in this case if all other interventions (e.g. therapy, exercise, monitored diet, etc.) have been exhausted and the illness demonstrates severe impairment in the child’s daily functioning.
Researchers supported by the National Institute of Mental Health have found that half of all lifetime cases of mental illness begin by age 14 and many are not seeking appropriate treatment. I see multiple patients with parents reporting a resistance in seeking treatment for the child, until the symptoms and behaviors were so unmanageable that hospitalization and medication were necessary for stabilization. As parents, providers and school personnel, recognition of changes in behavior or mood in children need to be taken seriously in order to implement appropriate intervention.
A tragic example was the Columbine shooting. One of students, Eric Harris, responsible for the deaths of several classmates was taking Luvox, which was approved by the FDA in 1997 for treating Obsessive-Compulsive Disorder. According to his court records, his dosage was increased about 3 and half months prior to the shooting. There was speculation on whether the medication may have had an “adverse reaction” for Eric leading up to the event. The Physicians Desk Reference states, during controlled clinical trials of Luvox, 4 percent displayed Manic reactions (e.g. exalted feelings, racing thoughts, delusions of grandeur). Whether or not Eric would have been involved in the school shooting if he was not on Luvox is unknown. Regardless, it was a moment in history to be aware of as the prescription of psychotropic medications continues to increase in youth.
When used appropriately, medication can significantly improve the lives of many struggling with chronic mental illness, however without further research on the impacts of children it should be used with caution. Several tips parents need to consider before administering medication to their child:
• Research: If you feel your child is presenting unusual symptoms or behaviors (e.g. irritability, excessive anger, anxiety, rapid mood swings, difficulty concentrating, etc.) talk to school personnel, friends within your community and utilize the internet to search for mental health professionals in the area.
• Thorough Evaluation: Include all symptoms and behaviors you see in your child in detail when communicating to the mental health professional. Make sure an appropriate assessment is conducted including presenting problem, medical history, psychiatric history, family history, substance abuse and prior medications taken. Don’t be afraid to ask questions, and if you dissatisfied with the evaluation seek out another professional.
• Prescribed Medication: Psychiatrists, pediatricians and nurse practitioners may suggest medication as part of treatment. It is only a suggestion and you should not feel pressured to administer medication to your child if you are not comfortable. Explore all possible side effects including any “adverse reactions” that may occur as well as any recent studies that have been done.
• Explore Treatment Options: There are a numerous outpatient providers who specialize in various disorders such as depression, trauma, reactive attachment disorder, play therapy, expressive arts, pervasive developmental disorders, etc. For children in need of a higher level of care, explore intensive outpatient and partial hospital programs. There are also numerous home-based programs often used to help prevent children in crisis from being hospitalized.
• Monitor Self-care: Educate and provide your child with a well-balanced diet consisting of fruits, vegetables, low-fat dairy, whole grains and healthy fats, while limiting processed foods and sugar intake. The preservatives in food can negatively impact sleep and mood. Encourage daily exercise and play. A study conducted by Duke found exercise is more effective in treating depression than antidepressant medications. Findings suggest exercise increases the neurotransmitters associated with elevated mood including norepinephrine, dopamine and serotonin. Sleep is also a crucial component in daily functioning. The recommended number hours of sleep for children ages of 3 to 12 is between 10 to 12 hours and 8 to 9 hours for children ages 12 to 18. This is the most important intervention of all and will help in improving various symptoms of mental illness.
Melissa Lambert M.Ed, Child and Adolescent Therapist, YFS1, Youth Nutrition Specialist.
Posted in Comments (1)
Excellent write up Melissa!
Please continue to put out great articles.