The 'atypical' dilemma
More and more, parents at wit's end are begging doctors to help them calm their aggressive children or control their kids with ADHD. More and more, doctors are prescribing powerful antipsychotic drugs.
Is it the parents or is it the schools who are asking for meds?
More and more, she said, they get referrals from the school system for disruptive kids. Parents tell her that the school has told them their children need to be put on psychiatric medication before they can come back - even though state law specifically forbids that.
The numbers are frightening.
In the past seven years, the number of Florida children prescribed such drugs has increased some 250 percent. Last year, more than 18,000 state kids on Medicaid were given prescriptions for antipsychotic drugs.
Even children as young as 3 years old. Last year, 1,100 Medicaid children under 6 were prescribed antipsychotics, a practice so risky that state regulators say it should be used only in extreme cases.
Medicaid? It looks like they are using children on welfare as guinea pigs.
These numbers are just for children on fee-for-service Medicaid, generally the poor and disabled. Thousands more kids on private insurance are also on antipsychotics.
Almost entirely driving this spiraling trend is the rise of a class of antipsychotic drugs called atypicals.
These drugs emerged in the 1990s and replaced the older, "typical" antipsychotics like Haldol or Thorazine, which are often associated with Parkinson-like shakes.
The atypicals were developed to treat schizophrenia and bipolar disorder in adults. But once on the market, doctors are free to prescribe them to children, and for uses not approved by the Food and Drug Administration.
What are they thinking?
There is almost no research on the long-term effects of such powerful medications on the developing brains of children. The more that researchers learn, the less comfortable many are becoming with atypicals.
Initially billed as wonder drugs with few significant side effects, evidence is mounting that they can cause rapid weight gain, diabetes, even death.
Why continue to use such dangerour drugs? Follow the money.
They're also expensive. On average last year, it cost Medicaid nearly $1,800 for each child on atypical antipsychotics. In the last seven years, the cost to taxpayers for atypical antipsychotics prescribed to children in Florida jumped nearly 500 percent, from $4.7-million to $27.5-million.
Medicaid and insurance companies have fed the problem, encouraging the use of psychiatric drugs as they reimburse less and less for labor-intensive psychotherapy and occupational therapy.
Another factor: Doctors have been influenced by pharmaceutical companies, which have aggressively marketed atypicals.
You would like to think a doctor would not base a diagnosis on marketing, but you would be wrong.
A recent New York Times analysis of those records found that doctors who took the most money from makers of atypicals tended to prescribe the drugs to children the most.
Here's another horrifying data point.
Using stimulant medications for ADHD should be "rare" for kids younger than 4, the guidelines state, "and only after a failed behavioral intervention such as parent training." Last year, 367 toddlers 3 and younger were prescribed ADHD medications.
Cavitt said 3-year-olds put on psychotropic medications typically are autistic, mentally retarded or brain injured. They are extremely self-injurious or physically aggressive to others, he said.
Robert Whitaker, a journalist and author of the book Mad in America, says there is no circumstance where it makes sense to prescribe an antipsychotic drug to a 3-year-old.
"It is not a scientific use of drugs," Whitaker said. "It is an experiment. There is no data showing that they are helpful in a 3-year-old kid. None. Zero. Zip."
The whole article is worth a look.
Related Tags: ADHD, school, parenting, antipsychotic drugs, Medicaid, atypicals, bipolar disorder, Risperdal, Zyprexa, Seroquel