Running head: THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL
CHILDREN IN AMERICA
1
The Medicated Child and the Increase of Mentally Ill Children in America
Licely Carcamo
From 2007 to 2010, there has been a 24% increase of diagnosed mentally ill children
(TV-Novosti, 2014, para. 7). The purpose of this paper is to explore how prescription medication
has enabled such a high diagnostic rate and the possibility that children are being over diagnosed
with mental illness. If so, what are the reasons and implications? In order to prevent this, there
needs to be a more thorough procedure when diagnosing children with mental illnesses in
America. This may be achieved through taking a closer look at their mental state and behaviors,
rather than the methods that are currently used. This will allow a proper diagnosis of a child.
A first step at looking for a solution towards the overmedication of children is to look at
the roots of mental illnesses. In the past, those who were mentally ill were looked as individuals
who did not meet the Gods’ expectations or were demonically possessed. Hippocrates (400 B.C)
was one of the first physicians to look at the mentally ill as a product of a disease, rather than
treating them as religious subjects. Later, Hippocrates used Hellebore as a purgative (PBS, 19992002). It is evident that diagnosing those with mental illness began early in time, however there
are no cases from such times in which children have been patients. The National Institute of
Mental Health publicized, “In the past, medications were seldom studied in children because
mental illness was not recognized in childhood” (National Institute of Mental Illness, 2009).
While children were not noted for being mentally ill, there was a recognition of adults with
mental disorders. Contrary to what was thought in the past, children are presently looked at as
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
2
the subjects of mental illnesses. Still, the question begs: what sparked the increase of mentally ill
children in America?
The acknowledgement of children with mental illnesses is a crucial next step at
identifying the increase of mentally ill children. Childhood depression was not recognized until
1975 at the National Institute of Mental Health conference. Weller states, “It was concluded that
adult criteria could be used to diagnose depression in children as long as appropriate
modifications to accommodate for age and stage of development were made” (Weller, Weller, &
Fristad, 1995, p. 709). If modifications are made during the diagnosis of depressed children, then
the method used would be appropriate. However if the criteria is not modified, there is a
possibility that the diagnosis of the child will not be accurate. A misdiagnosis would lead to
improper care of a child who either: does not need an exaggerated treatment, or is receiving a
lack of attention for their disorder. It can be considered imperative to adjust the analysis of each
child, since their mind greatly differs from that of an adult.
The most prevalent types of mental illnesses among children appear to be bipolar
disorder, depression, anxiety disorders, and Attention Deficit Hyperactivity Disorder (ADHD).
An estimated 7% of children living in the country meet the definition of bipolar. Of which, the
youngest of them are diagnosed beginning at age six (Brain & Behavior Research Foundation,
para. 2). Meanwhile, Harvard Medicine announced that 2.5% of children and 8.3% of teens
currently suffer from depression (Harvard Health Publications: Harvard Medical School, 20002014, para. 1). An estimated 8 percent of teens ages 13-18 have noted an anxiety disorder
(National Institute of Mental Health). As well as an overall 5% of children ages eighteen and
under currently suffer from ADHD (Centers for Disease Control and Prevention, 2013, para. 3).
Yet, the number of children with mental illnesses seem to correlate, as The Brain and Research
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
3
Institution suggests, “many bipolar disorder symptoms can resemble or ‘co-occur’ with those of
other childhood-onset mental disorders” (Brain & Behavior Research Foundation, para. 5).
Therefore, if a child is diagnosed with bipolar disorder, but also has co-occurring symptoms of
depression they must receive treatment for their diagnosis. This can be considered a form of
mis/underdiagnosis. Consequently, it will affect the way they are treated for the disorder. The
treatment the child receives will revolve around prescription medications. Furthermore, a next
step at looking for the underlying cause of mentally ill children is the types of medications they
are receiving.
Contrary to using Hellebore to treat the mentally ill, there is now a variety of prescribed
treatment individuals are submitted to. They have not always been proven effective. Children
solely suffering with ADHD have commonly been prescribed Ritalin in order to enable a higher
level of concentration. If a child has co-occurring ADHD and anxiety, they are given stimulants.
The stimulants may cause an increase in anxiety in the patient (Tartakovsky, 2011, para. 11).
This treatment can be rendered counterproductive, as the child is not receiving proper medication
to treat their disorder. Instead of helping them, it is stimulating their condition. Patients receiving
antidepressants are also at risk of receiving faulty treatment. According to the Mayo Clinic,
“Some studies have shown a possible link between starting treatment with an antidepressant and
an increased risk of suicide” (Mayo Clinic Staff, 2012, para. 4). While there may have been
studies showing that there is a risk of suicide when taking the medication, it is important to take
into consideration that not taking antidepressants will enable the patient to continue with the
same symptoms as before. It is plausible that their condition may worsen. While it is important to
treat the patient with such prescribed medications, it is also important to closely monitor them
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
4
and thoroughly diagnose the patient. Still, what exactly are the steps taken in order to diagnose
an individual with a serious mental illness –especially a child?
In certain instances, it has been noted that children may not be properly diagnosed. The
Frontline documentary, Medicating Kids demonstrates cases in which there is an ambiguity in
children with mental illnesses. In the film, a three year old boy named Nicholas DuPerret is
suspected of having ADHD. After watching the film of DuPerret in class, Edward Cable Psy.D,
suggested that he undergo an examination of the disorder by answering a series of multiple
choice questions (Gaviria & Smith, 2001). It does not seem plausible that a thorough diagnosis
can be completed through a short film of a child’s behaviors, or a series of multiple choice
questions. Is it fair to look at a three year old who displays signs of being content –beyond that
of his classmates, and diagnose him with ADHD? Also, the matter becomes complex when the
potentially ill child is young. Their mentally may not be capable of answering such defining
questions. While Fristad stated that children could be diagnosed for the same mental illnesses as
adults as long as their criteria was adjusted, an examination such as the one Cable performs does
not seem to meet these standards. Rather, it appears to be an oversimplified examination that has
the potential to lead to an overdiagnosis.
Conversely, there have been cases in which children have been underdiagnosed. Such
instances prove that not all cases involving a child are over-diagnosed. In fact, certain cases
show that children have been underdiagnosed. In Bipolar Disorder in Children: Misdiagnosis,
Underdiagnosis, and Future Directions (1995), Weller looks at a series children declared with
ADHD. However after a more extensive diagnosis, they were found to have Bipolar Disorder.
Weller states, “…it appeared mania may have been underdiagnosed in these children” (p. 710).
Similar cases suggest that there be a more thorough examination of suspected mentally ill
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
5
children. While over diagnosis has grave implications such as hyper medication and possible
future addiction, under-diagnosis also has the potential to be harmful towards the child. This may
lead to a disorder that lacks attention, and may consequently worsen their condition.
Taking in to account the increase of diagnosed children, it is evident that there has been
leeway in the medical community. The flexibility has notably been granted by the United States
congress. Daniel F. Connor MD shares, “Beginning in the 1990s, Congress expanded eligibility
criteria for Medicaid, especially for children. This fueled a rapid increase in coverage for
psychotropic medications, including stimulants” (Connor, 2001, p.1). Consequently, a majority
of the prescription medications given to children fall under the category of psychotropic. While
the expansion of Medicaid for children can be looked at as beneficial because it has aided many
individuals through the treatment of their disorder, it can also be looked at as an open door for
some to take advantage of. Thus, it permits a lack of attention towards the patients.
One corrupted aspect of the flexibility in the field of mental illness is the accessibility
doctors have to prescribe medicine to their patients. The leeway that Medicaid has given allows
the increase in prescription medications to be two things. The first is: Positive. Low-income
families with mentally ill children now have accessible treatment. This is constructive for those
who would otherwise have limited access to healthcare. However, this may also be a negative
thing. It leaves room for the pharmaceutical industry to take advantage of such system as well.
The Citizens Commission on Human Rights reported, “From 2000 to 2005, drug maker
payments to Minnesota psychiatrists rose more than six-fold to $1.6 million” (Citizens
Commission for Human Rights International, 2014, para. 4). This report comes shortly after
congress made adjustments to Medicaid. Due to the expansion in psychotropics within the
program, there was a noted increase in prescription. This can be explained by increase in
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
6
payments psychiatrists in Minnesota were receiving. While this report solely addresses the
Minnesota increase, it leads to the possibility of the same thing occurring in other states across
the nation. The financial compensation of psychiatrists does not outweigh a child’s need for
proper diagnosis and treatment. This only stresses the flawed system that is the medium through
which children are deemed as mentally ill.
Therefore, the method by which children in America are being diagnosed for mental
illnesses must be improved. Creating a generation of children that are underdiagnosed or
overdiagnosed may lead to a society that heavily relies on prescription treatments. It leaves room
for children such as DuPerret to receive medication they do not necessarily need. Likewise,
children are exposed to a lack of care. In addition, the compensation psychiatrists receive for
overprescribing further demonstrates that the current diagnostics procedure is not reliable. This is
neither sensible to the exposed children, nor to the society who has to eventually deal with the
problem of untreated or overmedicated children. In order to avoid such dilemma, a more
thorough examination of these diagnosed children must be made.
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
7
References
Brain and Behavior Research Foundation. (n.d.). Bipolar Disorder in Children. Retrieved from:
http://bbrfoundation.org/userFiles/facts.bpdchildren.pdf
Centers for Disease Control and Prevention. (2013). Attention Deficit Hyperactivity Disorder:
Data and Statistics. Retrieved from: http://www.cdc.gov/ncbddd/adhd/data.html
Citizens Commission on Human Rights International. (n.d.). The Corrupt Alliance of the
Psychiatric-Pharmaceutical Industry. Retrieved from: https://www.cchrint.org/issues/thecorrupt-alliance-of-the-psychiatric-pharmaceutical-industry/
Connor, D. (2011). Problems of Overdiagnosis and Overprescribing in ADHD. Psychiatric
Times. Retrieved from: http://www.psychiatrictimes.com/adhd/problems-overdiagnosisand-overprescribing-adhd/page/0/1#sthash.QIw2HYGB.dpuf
Gaviria, M., Smith, M. (Producers), & Gaviria, M. (Director). 10 April 2011. Medicating Kids.
The United States: Frontline.
Harvard Health Publications: Harvard Medical School. 2000-2014. Depression in Children and
Teenagers. Retrieved from: http://www.health.harvard.edu/newsweek/Depression_in
_Children_and_Teenagers.htm
Mayo Clinic. (2012). Suicide and Suicidal Thoughts: Risk Factors. Retrieved from:
http://www.mayoclinic.org/diseases-conditions/suicide/basics/risk-factors/con-20033954
National Institute of Mental Health. 2009. Treatment of Children With Mental Illness. Retrieved
from: http://www.nimh.nih.gov/health/publications/treatment-of-children-with-mentalillness-fact-sheet/index.shtml
THE MEDICATED CHILD AND THE INCREASE OF MENTALLY ILL CHILDREN IN
AMERICA
8
National Institute of Mental Health. (n.d.). Anxiety Disorders in Children and Adolescents.
Retrieved from: http://ftp.nimh.nih.gov/health/publications/anxiety-disorders-in-childrenand-adolescents/index.shtml
Tartakovsky, M. (2011). When ADHD and Anxiety Occur Together. Psych Central. Retrieved
on March 10, 2014, from http://psychcentral.com/lib/when-adhd-and-anxiety-occurtogether/0009860
TV-Novosti. (2014). Mental Health Hospitalizations for Children Increased Almost One-Quarter.
Retrieved from: http://rt.com/usa/children-mental-health-hospitalization-666/
Weller, E. B., & Weller, R. A. (1995). Bipolar disorder in children: Misdiagnosis,
underdiagnosis, and future directions. Journal Of The American Academy Of Child &
Adolescent Psychiatry, 34(6), 709.