03.02.10

The Overmedicated Myth

Are doctors and parents trying to “perfect” children through various cocktails of medications? That’s what Judith Warner assumed, until she began researching her new book—and found that we are not, after all, a Ritalin nation.

Aren’t all kids on some kind of medication? Isn’t everyone diagnosed with something these days? Isn’t ADD as common as the sniffles?

Not really, says Judith Warner, author of the new book We’ve Got Issues: Children and Parents in the Age of Medication. Warner is best known for outing the culture of overparenting in her first book, Perfect Madness: Motherhood in the Age of Anxiety, and her Domestic Disturbances column on The New York Times Web site, and now she’s decided to quiet the cacophony of misconceptions about children, medication, overdiagnosing, and overmedicating in one confident hush.

How does Warner do it? She starts by challenging her own beliefs.

The overmedicated and overdiagnosed child, Warner argues, is a media embellishment. And it’s become an obsession and storyline that eclipses the realities.

When she began writing her book, almost five years ago, she came to it thinking the narratives the media had spun about children and medication were true: Parents were trying to “perfect” their children through various cocktails of medications; doctors were going prescription-happy; and kids who occasionally got sad were being labeled “depressed.”

“Those assumptions, however, weren’t borne out by clinicians, parents, children, or statistics,” says Warner, who did lots of research to support her thesis.

Here’s what the numbers teach us:

About 5 percent of kids take psychiatric medication and, depending on how one reads the data, anywhere between 5 and 20 percent of kids today have mental-health issues. We are not a Ritalin nation. According to The National Institute of Mental Health, attention deficit disorder occurs in about 3 to 5 percent of school-age children.

book-cover---weve-got-issues
We’ve Got Issues: Children and Parents in the Age of Medication. By Judith Warner. 336 pages. Riverhead. $26. ()

The overmedicated and overdiagnosed child, Warner argues, is a media embellishment. And it’s become an obsession and storyline that eclipses the realities.

We’ve Got Issues spotlights a bigger problem: the lack of medical care for many children with mental issues. With an overwhelmed mental-health industry—there are only 7,000 child psychiatrists in the U.S., mostly concentrated in urban areas—those who need help often don’t get it. Mental-health issues have been portrayed as a bourgeois malady because that is the only segment of our population that can afford to have them. The full battery of tests to get a diagnosis costs about $2,000, which insurance companies often do not reimburse. Warner takes a stab at offering some policy solutions, including a clarion call for insurance companies to reimburse families for diagnostic tests and to increase the number of child psychiatrists.

She quotes John March, a Duke University psychiatrist, as saying, “Child psychiatry will really be the heart of psychiatry in the future. Epidemiology now shows that if you’re mentally ill as an adult, you first were mentally ill as a child or an adolescent.”

We’ve Got Issues is a reality check that separates the perceived outrages from the genuine ones, and for this alone Warner provides a real service.

Warner is saying “bring it on” to all the dicey, controversial, and murky areas that obscure the subject of children and medication, and she’s not afraid to acknowledge the issues on which there isn’t consensus, including whether there really are more children with mental issues today than there were 30 years ago. “I don’t know if there really are more, or we are just recognizing them more,” says Warner.

Still, she devotes a chapter to exploring the topic. One of the more intriguing explanations is “assortative mating,” a theory that researchers say could be one explanation for the mysterious surge of autism in our time. The theory is that today kids are getting a “higher genetic load” because people are now marrying mates who are similar to them. “Even one generation back you didn’t have a physicist marrying a physicist,” says Warner. Dr. Demitri Papolos, an associate professor of psychiatry at the Albert Einstein College of Medicine, says that in the past “spousal selection took into consideration knowledge of the partner’s family... now few couples have much of a clue as to the medical and psychiatric history of families they are marrying into.”

As for medication, Warner doesn’t get righteous; she looks at the facts.

In 2005, Darshak Sanghavi, chief of pediatric cardiology and an assistant professor of pediatrics at the University of Massachusetts Medical School, wrote a piece for The Boston Globe under the headline “Time to calm down about Ritalin,” arguing “the increased diagnosis and treatment of ADHD may be a major public health success story.”

Taking Warner’s trademark nuanced tone, We’ve Got Issues comes down on Sanghavi’s side. “I talked to one doctor who is trying to retrain the cerebellum, I talked to one doctor who believes in transcendental meditation, and I have read about many other alternative treatments, and all of them said these therapies can supplement medication, but most of the time for most children they don’t end up replacing medication entirely,” says Warner.

Statistics and studies aside, Warner humanizes the issues for the reader. Throughout the book she introduces parents of children whose lives were saved by medication: children who used to scream and kick for four hours while they did their homework were able, with the help of the right medication, to do it in half the time without the temper tantrums; children who might never have been able to emancipate (read: go to college) if they hadn’t been on mood stabilizers.

Warner, however, is anything but glib—that’s virtually impossible in a book that has close to 50 pages of notes—about medication, and We’ve Got Issues certainly isn’t a paean to the prescription pad, but, like a good journalist, she sees it from all sides.

“I can understand why parents think medication is scary,” she says. “It hasn’t been around long enough and it can have terrible side effects, but many parents get to a point where they feel it is unfair to the child not to be on the medication, where they come to feel the benefits outweigh the risks.”

The book is most successful at changing the narrative about children with mental-health issues. Of course there are pill-pushing parents, overdiagnosing psychologists, fraudulent drug companies, and irresponsible doctors, but there’s another truth that Warner shakes out: A lot of medications do work, not all parents are making their children into sacrificial lambs to their own ambitions, and a number of children do suffer from mental health issues. Parents will find solace in seeing their own experiences validated on Warner’s pages.

So has Warner, who once helped coin the term “helicopter parent,” done a 180 on parenting?

Yes.

“The more you talk about these parenting issues, the more tiresome it becomes to be a scold rather than empathetic,” she says. “The things that I heard about Perfect Madness—particularly from doctors and children’s advocates—was that I could have been more compassionate, and that really stuck with me.”

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Hannah Seligson is a journalist. Her book, A Little Bit Married: How to Know When It’s Time to Walk Down the Aisle or Out the Door, which spotlights and uncovers a major trend in dating today, the long-term unmarried relationship, will be published by Da Capo Press on Jan. 15.