Psychiatric over medication in children

Studies show that there has been an increase in the prescription of anti-psychotic medications to children. In my experience I have found that many young children are prescribed multiple medications as a quick solution to correct behaviors. Why this happening now is is a question we must ask? What has changed over the years? Is it the availability of medications? Is it the change of tolerance in society?

First and foremost we need to answer why antipsychotics would be used in young children. I think "Aggression" as a symptom and behavior is why they get such medications. But aggression is innate to all animals and human beings alike. In nature the ultimate stopper to aggression is fear. In all animals this is an instinctual operation. In humans this role through evolution has been outsourced to our intellects. Hence, the first brake for human aggression is our intellectual capacity to suppress it and the second one is fear.

In today’s society there is no patience for dealing with aggression. The first prescriber is often the primary care practitioner. It is know that the anti-psychotic medications like Risperidone, Abilfy, Olanzapine and Seroquel decrease aggressive behaviors. Hence, they are prescribed more easily no matter what the diagnosis or psycho-social circumstance are, e.g. ADHD versus Mood or Psychotic Disorder, or a dysfunctional family setting. There is also a shortage of Child Psychiatrists in overwhelmed clinics leading to the quick prescribing of these medications to cater to the pressures of desperate parents and other systems such as schools, foster agencies etc.  These factors have dramatically increased the unnecessary use of powerful medications with no foresight into the future consequences of prescribing them without proper justification. 

There is always room for improvement in practice and prescribing. There are clinically sound reasons for the use of these medications in young children under the supervision of a child psychiatrist with proper justification.

Hyper All The Time

There are two types of kids with ADHD, those who have some Hyperactivity and more Inattention and those who are always extremely Hyperactive with Attention out the window. In the first kind I prefer to use a single stimulant medication, i.e. either dextro-amphetamine (Dexedrine, Vyvanse Adderall) or methylphenidate preparation (Concerta, Medatate, Ritalin). These are kids who predominately need the medication to be functional at school or other structured activity and in general can be hyper and manageable at home. In the second kind, I prefer to use medications such as Clonidine (Kapvay) and Guanfacine (Tenex and Intuniv). I find that the hyperactivity needs to be contained first and with more of a 24/7 coverage. A stimulant can be used in conjunction. Strattera by itself or with Clonidine or Guanfacine is also very effective in extremely hyper motoric children.