Colleen Webster* never imagined she'd need to medicate her own child. Webster, who has a master's degree in special education, is an expert in behavior modification. Then Aaron* was born. "Early on, we knew something wasn't right," says the Charlotte, North Carolina, mom. Even as an infant, he was irritable and anxious -- so anxious that Webster had to make sure he was the first baby to arrive at daycare every morning so the whole staff could help him adjust. By age 2, Aaron was given to uncontrollable rages: biting, hitting, spitting. Friends told Webster that her baby's behavior was just an extreme version of the terrible twos. It took five doctors for Aaron to get a diagnosis at age 4: early-onset bipolar disorder.
Therapy had no effect on Aaron's outbursts. Webster and her husband finally agreed to try medication, but watching what the drugs did to Aaron was, she says, literally nauseating. Meds for attention deficit hyperactivity disorder (ADHD) made him manic and anxious: "He was cowering in my husband's armpit." An anticonvulsant caused hallucinations: "He would shriek that he saw bugs." A tranquilizer made him extremely uninhibited: "He would do things like pull his pants down in public and rub his private area."
Aaron, now 6, is currently doing well on Seroquel, an antipsychotic, and lithium, long prescribed for classic adult bipolar disease. He's affectionate, responds appropriately to discipline, and is able to go to school in a regular classroom. "I know there are many people who believe that parents use these kinds of drugs as a quick fix," says Webster. "But every time he has to try a new medication, I'm a nervous wreck -- I spend hours researching the pros and cons, I call his school repeatedly to see how he's doing. I watch him like he's under a microscope."
But, she says, the alternative to meds is even worse: "No one knows what it's like to have a child who bites through your skin when he doesn't get what he wants, who threatens to kill you -- and then, a minute later, comes to you with tears running down his face, so remorseful, and says, 'Mommy, I want to go to sleep and never wake up.'"
Drugs: Lifesaving or dangerous?
Moms like Colleen Webster often feel harshly judged by other parents, who wonder how a young child could possibly need not just one but several big-gun psychiatric medications. It doesn't help that the medical community is divided on the issue. Many doctors think young children now take too many dangerous drugs, the long-term effects of which aren't yet known. But others believe these are lifesaving medications for life-threatening conditions. The issue has become tormentingly complicated.
No one knows how many children are being diagnosed with mental illness -- ranging from bipolar disorder to more recently recognized conditions like oppositional defiant disorder -- and being treated for them. According to one study, behavioral medications for children accounted for 17 percent of all spending for pediatric drugs, more than even antibiotics and allergy drugs. And a study in Pediatrics showed that 19 percent of all pediatric visits among 4- to 15-year-olds involve a psychosocial problem requiring attention or intervention, making such problems the most common chronic reason to consult a pediatrician.
Cultural changes could explain the rising tide of pediatric prescriptions. Overcrowded classrooms can make teachers less tolerant of students who are unable to sit as still as their classmates -- sometimes to the point of recommending that parents consider meds. Parents are more willing to consider a drug, even for their kids, because advertising by pharmaceutical companies has destigmatized the whole idea of medication. And because of the way insurance companies reimburse physicians, doctors may be more likely to prescribe drugs than therapy: "A psychiatrist who schedules four medicine checks in an hour earns about twice as much from an insurance company as he would for forty-five minutes of counseling," says Lawrence H. Diller, M.D., a behavioral pediatrician and the author of Should I Medicate My Child?
Many critics note that with drug-company payments to doctors on the rise, it's not surprising that prescription writing has also increased. The New York Times found that in Minnesota (the only state that requires doctors to report payments from drug companies) payments to psychiatrists were six times higher in 2005 than they had been in 2000. During the same period, prescriptions for antipsychotics rose ninefold.
And yet, as Demitri Papolos, M.D., coauthor of The Bipolar Child and director of research at the Juvenile Bipolar Research Foundation in Maplewood, New Jersey, notes, "These families are constantly in crisis. Every day is heart-wrenching." Dr. Papolos, who advocates treating kids with drugs when appropriate, says, "Early intervention makes a big difference in terms of what happens in the life of the family."
Margaret Renkl is a contributing editor.
* Some names in this story have been changed.