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Has the world--and American society in particular--simply become a more destabilizing place in which to raise children? Probably so. But other factors are at work, including sharp-eyed parents and doctors with a rising awareness of childhood mental illness and what can be done for it. "While we don't know exactly why the incidence of psychopathology is increasing in children and adolescents, it probably has to do with better diagnosis and detection," says Dr. Ronald Brown, professor of pediatrics at the Medical University of South Carolina.
Also feeding the trend for more diagnoses is the arrival of whole new classes of psychotropic drugs with fewer side effects and greater efficacy than earlier medications, particularly the selective serotonin reuptake inhibitors (SSRIs), or antidepressants. These have been rolled out with highly visible, to-the-consumer ad campaigns. While an earlier generation of antidepressants--tricyclics like Tofranil--didn't work in kids, SSRIs do. According to a study by Professor Julie Zito of the University of Maryland School of Pharmacy, use of antidepressants among children and teens increased threefold between 1987 and 1996. And that use continues to climb.
Nobody, not even the drug companies, argues that pills alone are the ideal answer to mental illness. Most experts believe that drugs are most effective when combined with talk therapy or other counseling. Nonetheless, the American Academy of Child and Adolescent Psychiatry now lists dozens of medications available for troubled kids, from the comparatively familiar Ritalin (for ADHD) to Zoloft and Celexa (for depression) to less familiar ones like Seroquel, Tegretol, Depakote (for bipolar disorder), and more are coming along all the time. There are stimulants, mood stabilizers, sleep medications, antidepressants, anticonvulsants, antipsychotics, antianxieties and narrowcast drugs to deal with impulsiveness and post-traumatic flashbacks. A few of the newest meds were developed or approved specifically for kids. The majority have been okayed for adults only, but are being used "off label" for younger and younger patients at children's menu doses. The practice is common and perfectly legal but potentially risky. "We know that kids are not just little adults," says Dr. David Fassler, professor of psychiatry at the University of Vermont. "They metabolize medications differently."
Within the medical community--to say nothing of the families of the troubled kids--concern is growing about just what psychotropic drugs can do to still developing brains. Few people deny that mind pills help--ask the untold numbers who have climbed out of depressive pits or shaken off bipolar fits thanks to modern pharmacology. But few deny either that we're a quick-fix culture, and if you give us a feel-good answer to a complicated problem, we'll use it with little thought of long-term consequences.
"The problem," warns Dr. Glen Elliott, director of the Langley Porter Psychiatric Institute's children's center at the University of California, San Francisco, "is that our usage has outstripped our knowledge base. Let's face it, we're experimenting on these kids without tracking the results."
THE CASE FOR MEDICATION