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Part of the reason for all the hurry-up drugging, say psychiatrists, is managed care, which, already disinclined to pay for longer, more costly talk therapy, is equally reluctant to foot the bill to make sure patients on pills are well monitored. In a perfect--or at least better--world, says Elliott, parents considering meds for their kids would have access not to one specialist but three: a pediatrician, a behavioral pediatrician and a child-adolescent psychiatrist. "Insurance companies talk about second opinions," he says, "but they don't actually like them."
The pharmaceutical companies could be doing better too--and if they don't, the government must push them to do it. There is a lot of money to be made in developing the next Prozac, but there is less profit if you test it for longer than the law demands. The Food and Drug Administration (FDA) doesn't require long-term studies that follow patients over decades. Its only requirement is toxicity trials that span six to eight weeks. In an effort to entice companies to conduct lengthier studies, the agency now grants an extension of six months of exclusive marketing rights to any company engaging in studies of a drug's effects on a minimum of 100 children for more than six months. "It's a relatively small amount of data," acknowledges Dr. Thomas Laughren, a psychiatrist with the FDA's psychopharmacology division, "but it's better than what we had before, which was nothing."
Until all these things happen, the heaviest lifting will, as always, be left to the family. Perhaps the most powerful medicine a suffering child needs is the educated instincts of a well-informed parent--one who has taken the time to study up on all the pharmaceutical and nonpharmaceutical options and pick the right ones. There will always be dangers associated with taking too many drugs--and also dangers from taking too few. "Like every other choice you make for your kids," says Chang, "you make right ones and wrong ones." When the health of a child's mind is on the line, getting it wrong is something that no parent wants. --With reporting by Dan Cray/Los Angeles, Alice Park/New York, Kathie Klarreich/Miami, and Leslie Whitaker/Jefferson City