The NIMH Director, Thomas Insel, MD., publishes a blog and posted a long and thoughtful piece about the question of whether children are over medicated on 6-7-14. It is a pretty long summary of a very thoughtful and detailed analysis of the actual trends and data about use of medication for treatment of children with mental health and behavioral problems He notes the well-documented increase in prescriptions of mh medications for children, but questions, “Is it possible that the increased use of medication is not the problem but a symptom? What if more children were struggling with severe psychiatric problems and actually the problem was not over-treatment but increased need?”

He goes on note,
But what if the increased use of medication reflected more children with severe developmental problems and more families in crisis?What if the bigger problem is not over-medication but under-treatment?Hearing that 7.5 percent of children are on medication (4.2 percent on psychostimulants) seems stunning, but knowing that 11 percent of children have a diagnosis of ADHD raises a possibility of under-treatment.In fact, evidence from nationally representative surveys of youth in the U.S. challenges recent concerns regarding widespread overmedication and misuse of medications, at least in adolescents .Among those with current mental disorders, only 14.2 percent of youth reported psychotropic medication use, and the majority who had been prescribed medications had a mental disorder with severe consequences, functional impairment, suicidality, or associated behavioral or developmental difficulties.
In light of the evidence that about 1 in every 12 youth suffer from a severe developmental, behavioral or emotional disorder, under-treatment remains a serious problem.
Of course, the problem may be both over-treatment and under-treatment.It is possible that children with issues that would be resolved by psychotherapy alone are receiving medication. It seems very likely, given the data in adolescents, that many who would benefit from medication and psychotherapy are receiving neither intervention. (bolding added)
He ends his blog with,
The possibility that there is a real increase in the number of children suffering with severe emotional problems, just as there is a real increase in the number of children with diabetes and food allergies, is not even considered (by press reports about the increased use of mh medications for children). Shouldn’t we be asking why so many children, at younger ages, are being seen for emotional and behavioral problems?

Overall, I think that it is a provocative blog posting, and it is refreshing, I think, to have an MD advocate that psychotherapy is underutilized for children with symptoms that usually are treated with medication.

Richard Sethre, Psy.D. L.P.

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