We stand at a crossroads in medicine today. Having practiced developmental pediatrics for the past 25 years, I have become increasingly frustrated by an alarming trend and find myself asking why we are drugging our children for the way they behave?
Several recent reports have highlighted this phenomenon and they are worth mentioning here.
- Last month the CDC reported that the number of children now being diagnosed with ADHD has risen by 53% in the past decade and now 1 in 5 high school boys is estimated to be taking medication for attention problems.
- Alan Schwartz has done some remarkably courageous reporting for the NY Times investigating trends in the overuse of psychotropic medication in children highlighted by the front-page article detailing the tragic suicide of Richard Fee, misdiagnosed with ADHD. (NYT Feb 1, 2013)
- The American Psychiatric Association has just published the new edition of the DSM 5, which loosens the diagnostic criteria for ADHD, which is expected to lead to increased prescriptions of stimulant medications (NYT Apr 1, 2013).
- The National Institute of Mental Health has announced its rejection of the DSM 5 diagnostic criteria as oversimplifying complex behavioral and psychiatric problems. It plans to create a new diagnostic system the Research Domain Criteria (RDoC) in an effort to support more objective research.
- A recent article by psychologist and author Marilyn Wedge appeared in Psychology Today claiming that there is less ADHD diagnosed in France because they do not use the DSM criteria.
- Investigative reporter Robert Whitaker’s recent book “Anatomy Of An Epidemic” uncovers the systematic medicalization of behavioral problems and questions whether psychiatric medications fix chemical imbalances in the brain or create them.
Taken together, these recent articles offer us a glimpse of a profoundly disturbing picture of what is happening in our society. It’s too easy to blame one cause for this problem. It’s too easy because life is complex and each child has a unique story that’s worth taking the time to sort out. When we over-simply the problem, we tend to look for the same quick-fix solutions that got us into this mess to begin with.
Let’s take a closer look at who’s to blame for medicating our children.
1. It’s too easy to blame the drug companies for our children’s problems
Robert Whitaker has done a remarkable job of uncovering the unscrupulous practices of pharmaceutical companies pushing their products on our children. But why is this such a surprise to us? Isn’t this the way big business works? Big Pharma has taken advantage of the doctor crunched for time by HMOs and has made millions of dollars convincing us that the quick fix is the best fix. Why should medicine be any different than any other business? Buyer beware.
2. It’s too easy to blame doctors for our children’s problems
Doctors certainly contribute to the rise in diagnosing and medicating our children since they ultimately are the ones writing the prescriptions. But let’s remember that our doctors’ training in ICUs and ERs is founded primarily on the wonderful successes of acute care medicine. We expect doctors to make accurate diagnoses and to fix our problems quickly and efficiently. But contrary to what the DSM wants you to believe, there is little evidence that the acute care approach alone is of long-lasting benefit for chronic disorders like ADHD or other behavioral problems.
3. It’s too easy to blame chemical imbalances for our children’s problems
It may seem comforting to believe that we can boil all behaviors down to a set of chemical equations but this is folly. There’s no blood test for ADHD or depression or bipolar disease. And even if there was, blood tests are nothing more than snapshots of a moment in time. When we buy into this belief, this gives the subtle impression that our children are somehow fundamentally broken inside when they are given a developmental diagnosis, This couldn’t be farther from the truth. Fixing the problem is not a matter of simply getting the chemistry right. When we do this we deny the true power that lies in the subtle complexity of moment-to-moment adjustments that are constantly taking place in our children’s day-to-day lives.
4. It’s too easy to blame diet for our children’s behavior problems
It is tempting to look for bad guys in what we feed our children. Dr. Ben Feingold was ridiculed back in the sixties for looking at how children’s behaviors could improve by removing sugar and artificial additives from their diet. Studies have subsequently validated this and I have personally witnessed the benefits of this approach for some children. Before we over-simply eating to a matter of chemistry, it is important to remember that it’s not just what we eat but our whole attitude about eating that needs careful examination. From the moment we are born eating defines our love, how we connect and exchange with each other. The story of our life is made by how, where, when and why we eat. This is what makes eating together the first classroom and a source of mindful attention.
5. It’s too easy to blame parents for our children’s behavior problems
Dr. Wedge’s wonderful article in Psychology Today adds to Whitaker’s reporting on how the DSM promotes medication use in children. She goes further suggesting that the lower incidence of ADHD in France may be due to stricter parenting. This too may be an oversimplification. Having spent years living in Europe, I can tell you that it requires a closer look at the whole attitude of family cohesiveness that includes traditions of honoring our elders, eating together every day, story-telling and other cultural habits that play critical roles in raising healthy children. This kind of oversimplification is a bit like claiming that the cure for heart disease is the Mediterranean diet without looking at the Mediterranean lifestyle.
6. It’s too easy to blame our schools for our children’s behavior problem
There is no doubt in my mind that the current trend in standardized testing has contributed to the demands for performance enhancement through medication use. Teachers are under enormous pressure these days and place that same pressure on parents, when their children are not keeping up in the classroom. Being forced to “teach to the test,” there is no time to help individual students with different learning styles find their way. When we put so much emphasis on grades and ignore the importance of emotional and social intelligence, the simplest solution to this assembly-line mentality is the quick-fix of medication.
7. It’s too easy to blame genetics for our children’s problems
One of the biggest fallacies of our view of life is that our genes actually cause our problems. This oversimplification has its basis in our deep faith in biologic determinism. Cutting-edge research has demonstrated that we live in a much more complex “epigenetic” relationship with our world where endless environmental factors are constantly switching on and off genes (both ours and those of the microbiome living in our gut). If we step back for a moment and see the big picture, we begin to appreciate the dynamic overlap of multiple factors (family, friends, technology, diet, lifestyle, school, etc.) that support or distort an individual child’s emotional experience. There is nothing mechanistic about this process. It is much more akin to growing vegetables than fixing clocks.
Helping each child grow takes time and a willingness to explore her potential for adaptation. Neuroplasticity ensures that behaviors can change. As I discuss in my book Fire Child, Water Child, attention can be trained and self-esteem can be successfully nurtured. Rather than taking the easy way out, let’s take the time to consider each child’s story with love and the patience of a caring heart. When we do so, we banish the one to blame and become part of the medicine that heals all wounds.