We’ve heard a lot lately about preschoolers and depression. The debate over whether it makes sense to diagnose a small child with a psychiatric disorder is contentious: how do you distinguish a mental health problem from the long and windy road of just plain growing up, and what if a child is exhibiting signs of depressions: sadness, lack of interest in play, irritability…is it really right to pathologize what could be a normal reaction to something in the environment, like family conflict?
But yesterday in The New York Times the debate intensified–we learned the story of a young boy, Kyle, who was prescribed medications starting at the age of 18 months. He was put on Risperdal, an antipsychotic, as a toddler, and after that, Prozac, sleeping and ADHD meds, all before the age of 3. The symptoms that started the barrage of medications: extreme temper tantrums.
He would hit his head on the wall, scream, and throw things. He lined up toys too, and according to his mom, his pediatrician was quick to diagnose him with autism and put him on the antipsychotic drugs–from there it was downhill. At six years old he was a drooling, sedated, overweight child who his mom described as a “shell.”
Antipsychotics aren’t approved for young children, so why is Kyle’s case more common than most of us would think?
Kyle’s doctors made an off-label prescription–doctors can legally prescribe a drug that is not FDA approved for a particular purpose if they think it’s clinical appropriate. One of Kyle’s doctors said he saw a desperate mom, an out-of-control child, and wanted to fix it. He gave the toddler antipsychotics and then, because you have to have a diagnosis to prescribe meds, he labeled him as having a bipolor disorder (Kyle’s diagnosis has changed many times).
Here’s the thing, as I mention in a recent Science of Kids article, brain growth in the first years of life is exponential: until the age of two or three, brain cells connect to each other at a breakneck pace–forming approximately 1.8 million synapses (bridges between neurons) per second.
So maybe there are reasons to think about medications for young children (I try not to have the knee-jerk, “this is wrong!” reaction about kids and meds because I know it’s complicated, and especially when parents and doctors are worried about safety and self-injury, it’s a joint decision to do what makes sense). But imagine the breathtaking pace of brain cells connecting, and imagine the chemical alterations of a heavy duty drug washing over the brain–influencing how and whether certain pathways connect.
Therapy first, I’d say. If a child’s behavior is off the charts, parents need support in coming up with behavioral plans, and maybe accessing family or individual play therapy. And that’s just the problem raised by the Times article–lower income families are more likely to have kids on hard core medications, in part because they don’t have access to other options.
Kyle is doing well now–weaned off of all drugs except Vyvnase for attention deficit. He’s a successful, smart, bouncy kindergartener–glowing report card and all.
Image: Flickr/Jen SFO-BCN
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