WBUR

Parents Divided By The Medication Debate

Massachusetts has more children’s mental health providers than most other states, routinely screens most children for mental health issues, and has Rosie D., the 2006 lawsuit that mandates adequate mental health services for kids on public health insurance. But several challenges remain.

In the second report of our week-long series, “Are The Kids All Right?,” we visit two local families who’ve taken divergent paths on whether to give their kids mental health medication.

The Donovan Family Chooses Not To Medicate: (For the other side of the debate, meet the Brennan family.)

BOSTON — Giving a child drugs to manage a mental illness is a difficult, personal decision. Here are two families who’ve struggled with it, and made different choices.

Liz Moore is a mother of four who lives outside Boston. Her 9-year-old daughter started showing signs of problems in kindergarten.

“Sometimes in class she would isolate herself,” Moore said. “She hid under a table. Sometimes she would hit her head against the wall. She saw herself negatively.”

In another town outside Boston, Deb Donovan was dealing with her 5-year-old son and his violent outbursts.

“You want to know if this is going to help Johnny develop into an adult who has a sense of self-worth and competence in the world. And we have no idea whether that is the case or not.”
– Dr. John Abramson,
author of 'Overdosed America'

“I’ve had the police come to my house,” Donovan said, referencing a statement her son made as a kindergartner on the playground.

Both women faced a choice that thousands of people in Massachusetts face every day: could medicine help my child’s behavior? It’s an extremely important choice for a parent to make, says Dr. John Abramson, a lecturer at Harvard Medical School and author of “Overdosed America.” Abramson says giving children medicine has a lot of unanswered questions.

“What we don’t know, what nobody knows, is what the long-term effect of that is,” Abramson said. “And as a parent that’s the real question we want to be asking. Not: ‘Will this help Johnny get through the third grade better?’ You want to know if this is going to help Johnny develop into an adult who has a sense of self-worth and competence in the world. And we have no idea whether that is the case or not.”

Even though we don’t know, nationally it’s estimated that 10 percent of kids ages 5-18 are medicated for behavioral disorders. That’s more than any other country in the world.

So what did Moore and Donovan do? Moore’s daughter was diagnosed with a mood disorder and she put her on mood-stabilizer drugs and an anti-depressant.

“After the medication she was able to focus better in school,” Moore said, “her moods were more stable (and) she didn’t get into those depressive episodes.”

Donovan, whose son has a complicated diagnosis of attention deficit disorder and some anxiety, briefly tried Ritalin, a stimulant. After a week, she took him off because he was cycling through bouts of extreme hyperactivity and then crashing into exhaustion. Instead, Donovan changed his environment. She put him in a private therapeutic school, altered his diet and put him in therapy.

Liz Moore's 9-year-old daughter is on mood-stabilizing drugs for a mood disorder. (Deborah Becker/WBUR)

Liz Moore's 9-year-old daughter is on mood-stabilizing drugs for a mood disorder. (Deborah Becker/WBUR)

“The things that have made the biggest difference have kept him who he is and brought out the best in him without having to chemically modify him,” Donovan said.

Two choices. They were made after extensive consultations with doctors, family and friends going through the same thing. But what these parents may not realize is that part of their decision-making may have been affected by larger forces, such as social pressure, marketing and poor diagnosis.

Dr. Gary Sachs says that when the diagnosis is right, research shows drugs work well. Sachs is the founding director of the bipolar clinic and research program at Massachusetts General Hospital.

“You respond to treatment for a disorder much better if you really have that disorder,” Sachs said.

Sachs says it’s not about whether we are prescribing the right amount of drugs to kids, but whether they are being correctly diagnosed at all.

“It’s at least three times as much evaluation time requirement I think to see the situation clearly as it is with adults,” Sachs said.

That’s because you need to talk with parents, teachers and pediatricians to get a full picture. And that’s something insurance companies don’t pay doctors for, Sachs says, so diagnoses are often rushed.

“We end up with a ‘name that tune’ kind of approach to diagnosis, which is often misleading,” he concluded.

But parent Moore, who is a psychiatric nurse, says she’s confident her daughter was correctly diagnosed.

“I guess I have an advantage knowing what the signs of a person with mood disorder are, but she’s been having mood swings since she was very young,” Moore said.

Mood swings in children are nothing new, says Robert Whitaker, a medical journalist who wrote, “Anatomy of an Epidemic.” But 20 years ago, children with behavioral problems were rarely medicated. Just in the past 15 years, there’s been a 40-fold increase in the diagnosis of bipolar in children. But Whitaker says there’s little research behind the increase.

“There was no biological discovery of a marker of depression in children,” Whitaker said.

Instead, Whitaker and others see a pharmaceutical marketing story as to why the prescribing of antidepressants to children took off in the early 1990s.

“The adult market is seen as saturated and it’s quite clear that they were looking for expanded markets and they started seeing we realize it’s an unrecognized problem,” Whitaker said.

Drug companies target doctors, says Harvard’s Abramson. The companies give out research grants, fund top academics and pay consultants.

“Virtually all the information about psychopathology that is treated by drugs in kids comes from drug companies,” Abramson said.

PhRMA, the lobbying group for leading pharmaceutical companies, says it supports more research on the use of medicines in pediatric patients. The National Institute of Mental Health says most medications used to treat young people are safe and effective. However, many of them have not been studied or approved for use with children but are still being prescribed. In a study by a Massachusetts advocacy group for kids with mental illness, the majority of families said they were very satisfied with medications for their kids because they worked.

AUDIO SLIDESHOW: Michelle Brennan talks about the decision to medicate her son. (Jesse Costa/WBUR)

Another local parent, Michelle Brennan, talks about the decision to medicate her son. Click here for an AUDIO SLIDESHOW. (Jesse Costa/WBUR)

Parents say there were not influenced by drug company ads, but they did listen to the experiences of other family members.

But there’s also peer pressure for medication. Donovan experienced it when her son was acting out at school.

“The message came across, and this is verbatim,” Donovan recalled, “that I was ‘being an irresponsible parent by not medicating my child.’ ”

And Dr. Greg Hagan, president of the Massachusetts Chapter of the Academy of Pediatrics, is concerned about kids who are in difficult homes and are pressured to be put on medication.

“That’s where I worry,” Hagan said. “I worry that kids are being medicated for social problems that are not of their making, and they may get to the point. It seems sad to me that we can’t intervene earlier for those kids.”

But Hagan also thinks there are lots of kids with attention deficit disorder not getting the medicines that would greatly help them. As for Moore, she wouldn’t consider taking her daughter off mood-stabilizing drugs because she’s better able to focus and make friends.

“I think it would be damaging to her not to be on medication right now,” Moore said.

Donovan says without drugs her son has transformed from a child who was explosive and aggressive to one who is calm, confident and expresses his creativity with the electric piano. Donovan says she knows “this is the best decision that I’ve ever made for my son.”

Two families, two choices about how to treat children with mental illness.

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  • http://www.catherinecorman.com Catherine Corman

    WBUR is doing listeners a great service with the series, “Are the Kids All Right?” But I’m troubled by Brady-Myerov’s story this morning. To medicate or to alter environment, Brady-Myerov suggests, that is the question. This is the worst of journalistic binary thinking. It neatly sets up the story — but falsely. Most children benefit from a combined approach, one that incorporates medication, therapy, and modified educational settings. A fraction of parents have the resources to pursue all options. The story is not, as WBUR suggests, parents pitted against each other in an ideological battle over Demon Meds, in which Big Pharma pulls the strings. It’s about having the resources as a nation and a state to make sure all children — all people — get the diagnoses, treatment, and services they so desperately need.

  • Boston35

    I really wish they had dove more into what Mrs. Donovan did for her son with dietary intervention and environmental changes. Just grazing over it doesn’t give parents enough of an idea or path to explore it when they have to make this tough decision, the school is breathing down your neck, and their kid it about to explode.

  • Hburg

    With respect, I think the series does a disservice by overuse in the titltle of the term “mental illness”. Is every child with an attention deficit condition, or even one with a diagnosis of ADD or ADHD, mentally ill? Clearly certain children deviate from some established norms, do not readily accept the authority of certain adults, or cannot sit still in a class room. The show’s unfortunate overuse of the phrase “mental illness” paints too many children too soon with this label. I think this could inhibit treatment in some instances, and result in overtreatment such as medicating the problem in others.

  • Steve Garson

    I think it is important for listeners to understand that one reason that these medications are not tested on children is “because they are children”. They are not legally able to make the decision of whether participating in a drug study is safe. This does not mean that there is not plenty of evidence supporting the use of medication….when necessary.

    As for myself, (age 54), I discovered that I had ADD when my children were diagnosed with ADD. I no take Concerta (a form of Ritalin) and it has changed my life. If I had been diagnosed as a teen, my college academic experience and my entire career would have been different.

    But parents cannot blindly go along with the prescription of drugs. General practitioners and internists, in general, do not have the experience. A well thought of child psychiatrist is important, as is therapy. The issue is so complicated. The sad thing is without health insurance, a whole class of the society cannot get the help they need. The impact is life-long.

  • Jerry

    Any child using powerful medication should also use some alternative therapeutic approaches that can help calm an overstimulated nervous system going haywire. Once hyperactivity is better controlled with ritalin, for example, a regular program of guided physical exercise is beneficial (many kids do not exercise all of their large muscles to the point where they are physically relaxed and therefore able to get the required sleep that leads to better mental balance and better insulin uptake, reduction of cortisol production, etc.). Add also a program of guided meditation (once children can focus long enough) to retrain the brain to calm itself. Probably why the weeks in the natural setting for the young man helped him. The usual stimulants and irritants to his body and mind were changed, and so his brain changed in response, which in turn changed the responses of his nervous system. A combination of medication, change in environment and diet, change in nervous system stimulation (natural instead of electronic pulses from machinery), and regular, intense physical exercise can help many kids.

    One wonders whether at the point where kids are about to enter middle school a cessation of academic training for a year or two for all kids, substituted by an intense physical education and meditation program, could lessen many of the major psychiatric and psychological problems young people face. Some children may benefit from such an approach even earlier. Resume academic training after physical/mental training is well established. Tai chi, tai kwon do, karate, mindfulness meditation, modified “boot camp” calisthenics and weight training, training for “personal best” in physical achievement,some forms of dance, yoga–boost endorphins, reduce cortisol, etc. Getting rid of physical training in this country has harmed many children in our schools.

    Not to minimize the reality of neuropsych illnesses which may well require medication, restraints, change from the usual home/school environment–at first. But a focus on restoring health–mental and physical–through a combined approach from a dedicated team of pediatrician, psychiatrist, nutritionist, pharmacist, and psychologist/therapist (for child and family responses), physical trainer is what has been lacking. Professionals working with a family need to work together to optimize care from each specialty in order to help the whole child recover.

  • MIke

    Type your comment here
    Having a child with emotional burdens is very difficult. Seeing their daily functioning suffer and their mood be negative, irritable or depressed breaks a parent’s heart. These are not simple conditions to diagnose and treat. Medication is often one part of a comprehensive treatment plan that should consider what else might help – therapy, changes at home, school program and activities that might all support recovery. Most of these services are underfunded and limited by insurers that are reflecting our values, a reluctance to pay for mental health services. Children get even less then adults and medication visits are favored by insurers. There is less argument, fewer limitations and better payment for minute of professsional time spent. Other interventions are more poorly paid, discouraged or not paid at all. We have a clear path that is adequately funded if we screen a child has having diabetes or anemia;much less so if they are screened for emotional disorders or in fact referred for treatment. Sometimes medication with its risks and limitations is the only answer supported by insurers

    • Claraisabelle

      You are so right. It’s very sad that the insurance companies will often only pay for prescriptions and not real treatment.

  • Noway

    Too many parents blaming bad parenting and horribly disciplined kids on “mental health.” Stop being your kids friend and start putting your foot down! Then you wont have to worry about bringing your kid to a shrink.

    • Desperate Mother

      How glibly you reply. Do you really think it is so black and white? How does a parent, a loving parent, a parent who only wants what’s best for their child, really know in this day and age if they are just “bad parents and horribly disciplining their child” or if their child really has a “problem?”

      I’m just back from one of several visits to our local mental health professionals to determine what my thirteen-year-old daughter’s “problem” really is. Before we even arrived at any real conclusion, one thing was made perfectly clear to me: medication is the magic answer. I’m not so sure. I very well MAY be guilty of bad parenting, of a lack of firm discipline. Yet here I am, at a crossroads, with a daughter who I love with every fiber of my being, having to decide between the two. AM I a bad parent? Have my husband and I simply failed her? OR, does she really have mental health issues that require medication?

      I left the mental health office today feeling like if I DIDN’T choose to medicate her, there was nothing good to come of that. That suicide, or at the least, self-medicating on a downward spiral would be the only things to follow. At one point, the intake professional asked me to leave the room and then asked my daughter if she was cutting herself! In the car driving home my daughter said, “I would NEVER cut myself.” I asked, “What? Where did this come from?” And she told me what the mental health professional had said. And THIS from test results that only indicated a PROBABLE potential for “inattentive” ADHD. On the low scale. No strong results. NO proof positive. NO over the top indications that my child was in real danger, was anything more or less than any other child growing up in this age of technology, where attention deficit really seems to be the norm, a fallout, if you will, from the computer age; where societal norms themselves seem to have failed her.

      For me, the only thing certain in this journey is that I, as her mother, am entirely alone in deciding her fate. . . My husband has washed his hands of it; has left me to decide. This is no small thing; a very heavy weight. God help me . . .

  • Claraisabelle

    To Noway: Mental illness and behavioral issues are completely separate subjects. Your comment is insulting to good parents who have a child with mental illness. There are many families who have several children and only one has mental illness. Do you think those parents parent all of the children differently? Ridiculous. This shows how uniformed people are about mental illness. Do you blame the parents if a child has cancer? This is an ILLNESS, not a discipline issue.

    • http://twitter.com/murmur55 murmur55

      This is false. NAMI preaches this dogma but it is incorrect. Parents can damage their children so much that they become psychotic. Only one child may be targeted. Investigate child dynamics.

  • MyWord

    Thanks very much to Jerry for your comments about exercise, meditation, and other self-care methods. Yes, mental illness is biochemical. And lots of things other than drugs/medication affect our biochemistry. For instance, regular exercise has been shown by various studies to be effective in relieving depression. Meditation and relaxation methods can have profound effects on brain function and balance of hormones and neurotransmitters. Nutrition is also very important. I recently treated an adolescent (I’m a mental health professional) who was having symptoms of anxiety and depression; it turns out she was hypoglycemic. Once we got her blood sugar stabilized through dietary adjustments, her mood symptoms were reduced by about 70%. Yes, we still had to deal with depression and anxiety, but she got tremendous benefit from addressing the medical/nutritional issue first. Another client, who had serious anxiety, drank coffee every morning. She often ended up with her whole body shaking after this caffeine intake.

    Anyone who is having mental health issues should be THOROUGHLY evaluated for medical issues that might be involved. For instance, if depression and/or anxiety are present, check for thyroid function, iron levels, hypoglycemia, vitamin B levels, and anything else your doctor thinks is a good idea!! And talk with a nutritionist – diet really matters.

    Also, children don’t exist in a vacuum. They are profoundly affected by what’s going on around them (as are adults, for that matter). Their school environments need to be evaluated, and adjustments made so their chances of success are optimized. As for families, we really need to get out of the dichotomy of “it’s the parents’ fault” or “it’s all about an internal illness.” Nobody’s perfect, and no parents are perfect parents – after all, it’s the hardest job in the world. This is not about figuring out who to blame. It’s about figuring out how current family dynamics are serving and undermining the child (it’s always a mix of both – because in real life, there are always shades of gray).

    Also, bear in mind that each child’s experience of a particular family can be VERY different. Often it’s not a matter of “poor parenting”, but really more an issue of a difficult fit between a particular child and his/her parent(s). For instance, I treated an individual who had shown signs of depression and social anxiety since early childhood. However, he was very bright and not given to aggression, so he “did well” in school. This means that he got good grades and was not involved in fights. On the other hand, he did have trouble making friends – he had some friends, but interacting with other kids was always stressful for him, and took a toll on his energy level. Unfortunately, because of their own personality types and limitations, his parents didn’t understand that his social discomfort was problematic. This individual went for many years without treatment, and his social deficits and mood symptoms continued to build as he had increasing difficulty completing social/emotional developmental tasks. He emerged as a very troubled adult, whereas he might have done quite well had the problem been addressed early on.

    This individual’s parents loved him, and were, in general, what one would call “good parents.” It’s just that their limitations intersected with their child’s limitations in a way that was quite problematic for his mental health and happiness. This sort of thing happens a lot. It’s nobody’s fault. Rather than blaming, let’s get better at reaching these kids and their parents, in ways that are constructive for everybody.

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