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The Effects of Treating Psychiatric Disorders in Children with Medicine

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As the sun rises over Phoenix, 4-year-old Shelby wakes. She sleepily uses the potty, dutifully washes her hands, and then accepts a white capsule from her mother, Victoria*. The blond-haired, blue-eyed little girl swallows the medicine easily. “And then she's off—to take care of the pets, play with play dough, and just be Shelby,” says Victoria. (*Last name has been withheld.)

The capsule contains 20 milligrams (mg) of Ritalin (methylphenidate), the prescription stimulant used to calm and focus children with attention deficit hyperactivity disorder (ADHD). After dinner, Shelby takes more meds—2.5 mg of Abilify and .05 mg of clonidine. The preschooler has been on daily medication since she was 2, when she slept only about four hours a night and threw frequent, violent temper tantrums that sometimes left her mother with bruises and bite marks. A psychiatrist at the local children's hospital diagnosed bipolar disorder. For a year, Shelby was on increasingly potent doses of Risperdal (risperidone), an antipsychotic, and Depakote (divalproex), an antiseizure drug that's also used to reduce mania.

But as her outbursts gave way to medication side effects including slurred speech, tremors, weight gain, and an inability to walk without stumbling, her mother sought another opinion. This psychologist disagreed with the initial diagnosis, suggesting that Shelby didn't have bipolar disorder but rather a combination of ADHD and oppositional defiant disorder (ODD). He prescribed Ritalin.

Two-year-olds being diagnosed with bipolar disorder and put on psychiatric meds? It sounds incredible, but across the country children are learning to swallow pills before they can tie their shoelaces. A 2007 study found about one preschooler in 70 was taking a psychiatric drug, such as a stimulant, an antidepressant, a mood stabilizer, an antipsychotic, or an antianxiety drug, says Mark Olfson, M.D., a Columbia University psychiatrist and researcher. While some doctors have been prescribing drugs to treat attention deficits and depression in very young children for more than a decade now, the use of antipsychotics to counter irritability and aggression in this age group is new. The change may be part of a larger trend of prescribing drugs—for any condition—to children. More than a quarter of U.S. kids and teens now take regular medication, according to Medco Health Solutions, Inc., the biggest U.S. pharmacy-benefit manager.

In spite of the growing number of young kids taking psychiatric drugs, these medications (with a few exceptions) are not specifically approved by the Food and Drug Administration for use in children under age 6. Why? Because little is known about how they affect the tiny brains and bodies of young children. “We have very little research to show how psychiatric medications affect the developing nervous system, for instance,” says Dr. Olfson. “This is a concern.”

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