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Last updated on Tuesday, February 14, 2012
(INDIANAPOLIS) - Just about everyone probably knows someone whose child is being medicated for attention deficit disorder, attention deficit hyperactivity disorder or a bipolar disorder.
The diagnoses are increasingly common at younger ages, but doctors and parents are sometimes at odds about how young is too young.
A Columbia University study showed that 1 in 70 preschoolers are taking a psychiatric drug, though the long-term effects on children of some of the brain-altering medications haven't been studied.
Some of the drugs are not approved by the Food and Drug Administration for children under age 6, but that doesn't stop physicians from prescribing them to toddlers, in some cases.
Jennifer Goodin is all too familiar with the dilemma. Doctors wanted to start her son, Carter, on psychiatric medication when he was 3, but she wanted to wait.
"It's hard, because you're giving a child a medicine that you don't really know what it's doing to them," Goodin said.
Carter, who was diagnosed with ADHD, is now 7. In his short life, he has already been on Strattera, Adderall, Zoloft, Daytrana, Kapvay and Intuniv, in addition to medicine he takes for the treatment of seizures.
Goodin said her son exhibited more negative behavior while on some of the medications and that other drugs sedated him so much that she could hardly get him out of bed in the morning.
Another prescription caused muscle twitches so severe that they made Carter cry, Goodin said.
The Goodins are still searching for the right mix of medications for their son, but they worry about the long-term effects.
"It's just a constant struggle and a constant battle, especially with him," Goodin said. "He's non-verbal, so he can't really communicate with us his reaction to the drugs. We just have to read that, but it's hard because you're giving a child a medicine that you don't really know what it's doing to them."
In many cases, even the experts don't know how a child will react to powerful medication.
Dr. Leslie Hulvershorn, a child and adolescent psychiatrist at Riley Hospital for Children, said there is no doubt the commonly prescribed psychiatric drugs are changing how young brains are developing.
Hulvershorn believes that while the medications can be extremely helpful for some kids, they can be very dangerous for others.
In her practice, she's seen young children over-diagnosed and drugs to treat them over-prescribed.
"Physicians and other mental health professionals are under pressure to code a diagnosis in order to be able to bill," Hulvershorn said. "Families will go from provider to provider and hear different diagnoses because it's just unclear what's going on at that age."
As a general rule, Hulvershorn only prescribes to children age 5 and older.
"You really have a hard time under the age of 4 and 5 differentiating between what's a typical toddler tantrum and what's a pathological behavior," she said.
Hulvershorn and other experts in the field of child and adolescent psychiatry are especially concerned about the off-label use of strong psychiatric drugs. That's when a drug is prescribed to treat a condition for which it has not been FDA-approved.
"For example, you might have a drug that's developed for schizophrenia that is then used to treat aggression in kids," she said. "We see a lot of kids coming in on those who've never even been on the appropriate medication for ADHD and were put on those first. So, I think that's a concern."
Hulvershorn said she had recently seen a case in which a child had been placed on several strong psychotropic medications that might be used to treat adult bipolar disorder or schizophrenia.
"He'd been on them for a long time and had really serious side effects," she said.
The side effects are a concern for Jennifer Gearlds, whose stepson, Kurt, began struggling with behavior problems at age 7.
"That's why we had never tried anything before. I was just cautious about trying different medications," Gearlds said.
The family turned to medication when Kurt was 8, but Gearlds said the meds made Kurt very, very angry and that he was hiding pills to avoid taking them.
The Gearlds laid off medication for six years. But recently, Kurt started taking a new prescription, with what the family called amazing results.
"A huge difference - his behavior is better. He's participating at home as a family all the time, not avoiding everything," she said. "He's brought all of his grades up from Ds and Fs to As and Bs."
"It was about maybe three or four weeks after I started taking it I could tell I was focusing a lot more," Kurt said.
With his grades up so dramatically, Kurt hopes to go to college and maybe eventually into sports broadcasting.
"I wish we would have done something sooner, so he would have liked school better and we wouldn't have had all the stress for the last at least five years," Gearlds said.
Hulvershorn said the biggest challenge parents often face is finding qualified child psychiatrists with experience in prescribing brain-altering medications.
"There's a shortage. In all of medicine, the biggest shortage of physicians is of child and adolescent psychiatry," she said. "It's very hard to find people who feel comfortable and have had adequate training to prescribe, and pediatricians are kind of left in the lurch with these kids who need help."
Hulvershorn advises parents to always get a second opinion and to seek out a physician with expertise in the particular diagnosis a child is dealing with.
Parents should always try therapy first and medicate as a last resort. If a child does go on medication, it should start with a low dose.
Until adequate testing is done, the possible long-term effects of some powerful drugs are unknown.
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