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Posted by Sylvia on Sunday, May 15, 2005 (21:12:22)
MSNBC
Hunter Walrath's parents were hopeful when a child psychiatrist prescribed Concerta for their 9-year-old son. A bright, highly verbal boy, Hunter has a laundry list of disabilities: he suffers from ADHD, faulty executive functioning, dyslexia and emotional problems that suggest Asperger's syndrome.
His limited attention span and poor impulse control made him an outcast at school. But the Concerta, his parents say, had little effect. His doctor upped the dose, but still, Hunter struggled. A few months later, when the doctor switched Hunter to a cocktail of Ritalin and Strattera, their boy's behavior changed—but not for the better.
He gained 25 pounds and his outbursts in class grew more intense. Back on Concerta, Hunter has improved and is starting a new school, but the Walraths are shaken. "Sometimes we wondered," says John Walrath. "Are the doctors making this up as they go along?"
The Walrath's aren't alone on the medication merry-go-round. In the last decade, the number of psychoactive medications available to children has more than tripled. And increasing numbers of children are taking the drugs, too.
In a national study completed this February, the New York University's Child Study Center found that 15 percent of parents with children between the ages of 5 and 18 reported giving their kids psychoactive medication daily.
When they work, psychoactive medications can be a godsend. But John Walrath wonders if Hunter's medical team "had a solid understanding" of his son's complex interplay of issues. "Those doctors' visits are fleeting," he says. Experts share the concern. In the Child Study Center survey, about 28 percent of parents who gave their kids drugs deemed the treatment "somewhat unhelpful" or "extremely unhelpful." "We find this worrisome," says Dr. Harold S. Koplewicz, director of the center, because it suggests that many kids may be on the wrong meds.
With only 7,000 child psychiatrists practicing in the United States and a growing wave of kids seeking treatment, "you have to wonder who is making the diagnosis," says Koplewicz. Most prescribing is done by a general practitioner or pediatrician, who may not have the time or expertise to do a thorough analysis.
The children who respond best to medication, experts say, are often the ones who fit snugly into widely recognized diagnostic categories like attention deficit or obsessive-compulsive disorders. For quirkier kids, whose symptoms are hard to classify or who seem to have several disorders at once, pinpointing the right treatment can depend more on clinical judgment than on hard science.
For those kids, says Dr. Richard Gorman, chairman of the American Academy of Pediatrics' Committee on Drugs, "there is a lot more ambiguity and a lot less data about what works." Medicine aimed at one set of symptoms can exacerbate other symptoms. Susannah Budington says that by the time her daughter Allison Stoll was 5, she'd already been diagnosed with ADHD but was prescribed Prozac to help manage her hypersensitivity, anxiety and an extreme phobia about bugs.
In first grade, though, Allison's teacher complained that while Allison was bright and kind, she was disruptive: she couldn't sit still and blurted out answers. So Stoll's psychiatrist added dexadrine to Allison's menu of meds. The next day, her mother noticed Allison was pulling out her eyebrows and her eyelashes. "The dexadrine overrode the Prozac," says Budington, who discontinued the dexadrine.
Even with the right drugs, determining the right dosage isn't easy. Children metabolize some drugs faster than adults—so pound for pound, they often require more. But too much medication has dangers, of course. Dr. Anne McBride, a pediatric psychopharmacologist at the Payne Whitney clinic in New York, has seen young patients suffering from agitation, sedation, cognitive dulling, abnormal liver and kidney function, and an impaired immune system. "They're toxic from too many drugs," she says.
In those cases, McBride retains the medications that are appropriately prescribed and withdraws the questionable drugs one at a time. Another challenge: children can "outgrow" a drug's benefits. From third to sixth grade, Khristopher Royal used Ritalin to help him stay focused in class. But in sixth grade, it simply stopped working. His doctor tried Aderall, dexadrine and Wellbutrin. "Nothing worked," says his mother, Karran Harper Royal. "It was frustrating."
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