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THE WHITE HOUSE
WASHINGTON
September 18, 2000
STATEMENT BY FIRST LADY HILLARY RODHAM CLINTON TO
THE SURGEON GENERAL'S CONFERENCE ON CHILDREN'S MENTAL HEALTH:
DEVELOPING A NATIONAL ACTION AGENDA
I want to applaud Surgeon General David Satcher for bringing together so many
advocates and experts today for the Surgeon General's Conference on Children's Mental
Health: Developing a National Action Agenda. The work you are doing today and
tomorrow has the potential to bring more health and hope to our nation's children -- and
more peace of mind to their parents.
Six months ago at the White House, I joined with Health and Human Services
Secretary Donna Shalala, Surgeon General Satcher, National Institute of Mental Health
Director Steve Hyman, FDA Commissioner Jane Henney, and Assistant Secretary of
Education Judith Heumann to launch an unprecedented public-private effort to improve
the diagnosis and treatment of children with emotional and behavioral conditions. We
came together to address recent troubling reports about the increasing number of young
children taking psychotropic drugs, and to help parents concerned about how to best help
treat their children.
According to a report in the Journal of the American Medical Association, the
number of preschoolers taking psychotropic drugs increased dramatically from 1991 to
1995. The increase for Ritalin alone was 150 percent, and the use of anti-depressants
increased over 200 percent. The number of children under the age of five taking
clonidine, which is used to treat insomnia in children with attention deficit disorders,
tripled. Unfortunately, many of the drugs being prescribed to our youngest children have
never been tested on them. None of them have been tested on children under 6, and many
have not been tested on children under 16.
As a parent and longtime children's advocate, these findings concern me a great
deal, as they do Federal health officials and countless other experts. But, let me be very
clear: Our goal has never been to attack these medicines. They have literally been a
Godsend for countless adults and young people with behavioral and emotional problems.
We know that when children are left untreated, they may fail to reach their God-given
potential later in their lives. That's why these efforts to improve the diagnosis and
treatment of children with behavioral and emotional conditions are so important. We
want the best information for every parent, every doctor, every teacher -- every single
person who cares for our children.
At the White House that day, we met with representatives from many of the
groups working on the frontlines on behalf of our children. We talked about what more
we could do to ensure that children with emotional and behavioral problems get the right
care at the right time. And we discussed many of the difficult questions, which the
participants in this conference will be addressing as they help the Surgeon General
develop an action plan for the future.
We asked, for example, how are we diagnosing, treating and caring for children
with behavioral and emotional conditions? Do we have the best tools to make the most
accurate diagnoses? When it comes to drug treatments for children, why are we seeing
such great variations by community and race? And what effects do overuse and underuse
of these medications have on our children? We also began to ask, why aren't we doing a
better job of combining drugs, when necessary, with family therapy and other behavioral
modifications? And what are the potential effects on our very youngest children who
have not been tested for these prescription drugs and whose brains are in their most
critical stage of development?
At this White House meeting, we announced some immediate steps to ensure that
children with behavioral and emotional problems get the care they need. I am pleased
that we are already making progress in meeting that goal. We know that more research is
necessary to ensure that we make more informed decisions about treatments for our
children. To address the gap in knowledge, we announced that NIMH would dedicate $5
million to conduct a landmark study examining ADHD and Ritalin use in preschoolers.
This five-year study, which NIMH has already begun funding, will shed much needed
light on the safety and effectiveness of Ritalin in young children.
Second, we announced that the FDA would look at some common psychotropic
drugs and begin determining what dosage levels are appropriate for very young children.
The goal is to put this critical information right on the drug labels. But, these studies will
also address the obvious ethical issues that arise when you examine the use of
prescription drugs in such a vulnerable group. The FDA's Pediatric Advisory
Subcommittee has already begun meeting to discuss these ethical issues, and to develop
protocols for making the best diagnosis in young children. In addition, in October, the
FDA and NIMH are holding a joint research meeting: "Psychopharmacology for Young
Children: Clinical Needs and Research Opportunities."
Third, information about proper diagnosis and treatment of children with mental
health problems has not reached many of the people who need it most -- including
parents, teachers, school nurses, social workers, pediatricians and family physicians.
Therefore, at our White House meeting, NIMH released a new, easy to understand fact
sheet to help parents make the right decisions about their children's treatment. The
American Academy of Pediatrics announced it would develop new guidelines to treat and
diagnose ADHD. Since then, those treatment guidelines have been issued, and they are
already giving vital assistance to health professionals everywhere.
Despite the progress already made, we know there are still many questions we
must confront. We must ask whether children diagnosed with emotional and behavioral
conditions are provided appropriate care in today's health care system. More specifically,
are they receiving the full range of services they require? Are these services being
managed appropriately? And does insurance cover the types of services necessary to
provide optimal care?
We also should look at the concerns that have been raised by physicians, patient
advocates, and other experts about the extraordinary increase in marketing expenditures
for a whole range of medications, including Ritalin. We need to determine whether such
marketing has encouraged excessive and inappropriate use of pharmaceutical products or
has been constructive in making the public more aware of available treatment options.
Moreover, we need to determine the implications of the increased use of these
medications in very young populations given the lack of knowledge about their long-term
effects.
We need to develop long-term strategies for addressing our children's mental
health needs, and your work today and tomorrow will play a large role in making that
happen. With your input, the Surgeon General will develop recommendations to improve
the way we diagnose, treat, and care for children with emotional disorders.
This week's conference is a very important step, but it is certainly not the last step.
I look forward to your recommendations and to working with all of you to ensure that
young people get the care they need to have the childhoods and futures they deserve.
STATEMENT BY FIRST LADY HILLARY RODHAM CLINTON TO
THE SURGEON GENERAL'S CONFERENCE ON CHILDREN'S MENTAL HEALTH:
DEVELOPING A NATIONAL ACTION AGENDA
September 18, 2000
I want to applaud Surgeon General David Satcher for bringing together so many
advocates and experts today for the Surgeon General's Conference on Children's Mental
Health: Developing a National Action Agenda. The work you are doing today and
tomorrow has the potential to bring more health and hope to our nation's children -- and
more peace of mind to their parents.
Six months ago at the White House, I joined with Health and Human Services
Secretary Donna Shalala, Surgeon General Satcher, National Institute of Mental Health
Director Steve Hyman, FDA Commissioner Jane Henney, and Assistant Secretary of
Education Judith Heumann to launch an unprecedented public-private effort to improve
the diagnosis and treatment of children with emotional and behavioral conditions. We
came together to address recent troubling reports about the increasing number of young
children taking psychotropic drugs, and to help parents concerned about how to best help
treat their children.
According to a report in the Journal of the American Medical Association, the
number of preschoolers taking psychotropic drugs increased dramatically from 1991 to
1995. The increase for Ritalin alone was 150 percent, and the use of anti-depressants
increased over 200 percent. The number of children under the age of five taking
clonidine, which is used to treat insomnia in children with attention deficit disorders,
tripled. Unfortunately, many of the drugs being prescribed to our youngest children have
never been tested on them. None of them have been tested on children under 6, and many
have not been tested on children under 16.
As a parent and longtime children's advocate, these findings concern me a great
deal, as they do Federal health officials and countless other experts. But, let me be very
clear: Our goal has never been to attack these medicines. They have literally been a
Godsend for countless adults and young people with behavioral and emotional problems.
We know that when children are left untreated, they may fail to reach their God-given
potential later in their lives. That's why these efforts to improve the diagnosis and
treatment of children with behavioral and emotional conditions are so important. We
want the best information for every parent, every doctor, every teacher -- every single
person who cares for our children.
At the White House that day, we met with representatives from many of the
groups working on the frontlines on behalf of our children. We talked about what more
we could do to ensure that children with emotional and behavioral problems get the right
care at the right time. And we discussed many of the difficult questions, which the
participants in this conference will be addressing as they help the Surgeon General
develop an action plan for the future.
We asked, for example, how are we diagnosing, treating and caring for children
with behavioral and emotional conditions? Do we have the best tools to make the most
accurate diagnoses? When it comes to drug treatments for children, why are we seeing
such great variations by community and race? And what effects do overuse and underuse
of these medications have on our children? We also began to ask, why aren't we doing a
better job of combining drugs, when necessary, with family therapy and other behavioral
modifications? And what are the potential effects on our very youngest children who
have not been tested for these prescription drugs and whose brains are in their most
critical stage of development?
At this White House meeting, we announced some immediate steps to ensure that
children with behavioral and emotional problems get the care they need. I am pleased
that we are already making progress in meeting that goal. We know that more research is
necessary to ensure that we make more informed decisions about treatments for our
children. To address the gap in knowledge, we announced that NIMH would dedicate $5
million to conduct a landmark study examining ADHD and Ritalin use in preschoolers.
This five-year study, which NIMH has already begun funding, will shed much needed
light on the safety and effectiveness of Ritalin in young children.
Second, we announced that the FDA would look at some common psychotropic
drugs and begin determining what dosage levels are appropriate for very young children.
The goal is to put this critical information right on the drug labels. But, these studies will
also address the obvious ethical issues that arise when you examine the use of
prescription drugs in such a vulnerable group. The FDA's Pediatric Advisory
Subcommittee has already begun meeting to discuss these ethical issues, and to develop
protocols for making the best diagnosis in young children. In addition, in October, the
FDA and NIMH are holding a joint research meeting: "Psychopharmacology for Young
Children: Clinical Needs and Research Opportunities."
Third, information about proper diagnosis and treatment of children with mental
health problems has not reached many of the people who need it most -- including
parents, teachers, school nurses, social workers, pediatricians and family physicians.
Therefore, at our White House meeting, NIMH released a new, easy to understand fact
sheet to help parents make the right decisions about their children's treatment. The
American Academy of Pediatrics announced it would develop new guidelines to treat and
diagnose ADHD. Since then, those treatment guidelines have been issued, and they are
already giving vital assistance to health professionals everywhere.
Despite the progress already made, we know there are still many questions we
must confront. We must ask whether children diagnosed with emotional and behavioral
conditions are provided appropriate care in today's health care system. More specifically,
are they receiving the full range of services they require? Are these services being
managed appropriately? And does insurance cover the types of services necessary to
provide optimal care?
We also should look at the concerns that have been raised by physicians, patient
advocates, and other experts about the extraordinary increase in marketing expenditures
for a whole range of medications, including Ritalin. We need to determine whether such
marketing has encouraged excessive and inappropriate use of pharmaceutical products or
has been constructive in making the public more aware of available treatment options.
Moreover, we need to determine the implications of the increased use of these
medications in very young populations given the lack of knowledge about their long-term
effects.
We need to develop long-term strategies for addressing our children's mental
health needs, and your work today and tomorrow will play a large role in making that
happen. With your input, the Surgeon General will develop recommendations to improve
the way we diagnose, treat, and care for children with emotional disorders.
This week's conference is a very important step, but it is certainly not the last step.
I look forward to your recommendations and to working with all of you to ensure that
young people get the care they need to have the childhoods and futures they deserve.
THE WHITE HOUSE
WASHINGTON
STATEMENT BY FIRST LADY HILLARY RODHAM CLINTON TO
THE SURGEON GENERAL'S CONFERENCE ON CHILDREN'S MENTAL HEALTH:
DEVELOPING A NATIONAL ACTION AGENDA
September 18, 2000
I want to applaud Surgeon General David Satcher for bringing together so many
advocates and experts today for the Surgeon General's Conference on Children's Mental
Health: Developing a National Action Agenda. The work you are doing today and
tomorrow has the potential to bring more health and hope to our nation's children -- and
more peace of mind to their parents.
Six months ago at the White House, I joined with Health and Human Services
Secretary Donna Shalala, Surgeon General Satcher, National Institute of Mental Health
Director Steve Hyman, FDA Commissioner Jane Henney, and Assistant Secretary of
Education Judith Heumann to launch an unprecedented public-private effort to improve
the diagnosis and treatment of children with emotional and behavioral conditions. We
came together to address recent troubling reports about the increasing number of young
children taking psychotropic drugs, and to help parents concerned about how to best help
treat their children.
According to a report in the Journal of the American Medical Association, the
number of preschoolers taking psychotropic drugs increased dramatically from 1991 to
1995. The increase for Ritalin alone was 150 percent, and the use of anti-depressants
increased over 200 percent. The number of children under the age of five taking
clonidine, which is used to treat insomnia in children with attention deficit disorders,
tripled. Unfortunately, many of the drugs being prescribed to our youngest children have
never been tested on them. None of them have been tested on children under 6, and many
have not been tested on children under 16.
As a parent and longtime children's advocate, these findings concern me a great
deal, as they do Federal health officials and countless other experts. But, let me be very
clear: Our goal has never been to attack these medicines. They have literally been a
Godsend for countless adults and young people with behavioral and emotional problems.
We know that when children are left untreated, they may fail to reach their God-given
potential later in their lives. That's why these efforts to improve the diagnosis and
treatment of children with behavioral and emotional conditions are so important. We
want the best information for every parent, every doctor, every teacher -- every single
person who cares for our children.
At the White House that day, we met with representatives from many of the
groups working on the frontlines on behalf of our children. We talked about what more
we could do to ensure that children with emotional and behavioral problems get the right
care at the right time. And we discussed many of the difficult questions, which the
participants in this conference will be addressing as they help the Surgeon General
develop an action plan for the future.
We asked, for example, how are we diagnosing, treating and caring for children
with behavioral and emotional conditions? Do we have the best tools to make the most
accurate diagnoses? When it comes to drug treatments for children, why are we seeing
such great variations by community and race? And what effects do overuse and underuse
of these medications have on our children? We also began to ask, why aren't we doing a
better job of combining drugs, when necessary, with family therapy and other behavioral
modifications? And what are the potential effects on our very youngest children who
have not been tested for these prescription drugs and whose brains are in their most
critical stage of development?
At this White House meeting, we announced some immediate steps to ensure that
children with behavioral and emotional problems get the care they need. I am pleased
that we are already making progress in meeting that goal. We know that more research is
necessary to ensure that we make more informed decisions about treatments for our
children. To address the gap in knowledge, we announced that NIMH would dedicate $5
million to conduct a landmark study examining ADHD and Ritalin use in preschoolers.
This five-year study, which NIMH has already begun funding, will shed much needed
light on the safety and effectiveness of Ritalin in young children.
Second, we announced that the FDA would look at some common psychotropic
drugs and begin determining what dosage levels are appropriate for very young children.
The goal is to put this critical information right on the drug labels. But, these studies will
also address the obvious ethical issues that arise when you examine the use of
prescription drugs in such a vulnerable group. The FDA's Pediatric Advisory
Subcommittee has already begun meeting to discuss these ethical issues, and to develop
protocols for making the best diagnosis in young children. In addition, in October, the
FDA and NIMH are holding a joint research meeting: "Psychopharmacology for Young
Children: Clinical Needs and Research Opportunities."
Third, information about proper diagnosis and treatment of children with mental
health problems has not reached many of the people who need it most -- including
parents, teachers, school nurses, social workers, pediatricians and family physicians.
Therefore, at our White House meeting, NIMH released a new, easy to understand fact
sheet to help parents make the right decisions about their children's treatment. The
American Academy of Pediatrics announced it would develop new guidelines to treat and
diagnose ADHD. Since then, those treatment guidelines have been issued, and they are
already giving vital assistance to health professionals everywhere.
Despite the progress already made, we know there are still many questions we
must confront. We must ask whether children diagnosed with emotional and behavioral
conditions are provided appropriate care in today's health care system. More specifically,
are they receiving the full range of services they require? Are these services being
managed appropriately? And does insurance cover the types of services necessary to
provide optimal care?
We also should look at the concerns that have been raised by physicians, patient
advocates, and other experts about the extraordinary increase in marketing expenditures
for a whole range of medications, including Ritalin. We need to determine whether such
marketing has encouraged excessive and inappropriate use of pharmaceutical products or
has been constructive in making the public more aware of available treatment options.
Moreover, we need to determine the implications of the increased use of these
medications in very young populations given the lack of knowledge about their long-term
effects.
We need to develop long-term strategies for addressing our children's mental
health needs, and your work today and tomorrow will play a large role in making that
happen. With your input, the Surgeon General will develop recommendations to improve
the way we diagnose, treat, and care for children with emotional disorders.
This week's conference is a very important step, but it is certainly not the last step.
I look forward to your recommendations and to working with all of you to ensure that
young people get the care they need to have the childhoods and futures they deserve.
The Washington Post
OOK
Commentary
Edit
Colun
Close to
SUNDAY, SEPTEMBER 17, 2000
DM
Don't Be Frightened
PHOTOCOPY
PRESERVATION
Of Medicine That Helps
Enough Scare Stories. Treat Kids Who Need It
By PATRICIA DALTON
their children live more normalives. While the JAMA study focused on
the very young, I knew it would alarm parents whose children were old-
W
hen the Journal of the American Medical Association report-
er. Sure enough, in my office I began hearing, "Aren't too many kids put
ed last February that there had been a dramatic increase in
on these drugs today? And I've heard they' dangerous."
the use of psychotropic medications for children between
Then, just last week, I was appalled to read news reports about law-
the ages of 2 and 4; I could see what was coming.
suits filed. in California and New Jersey accusing Novartis Pharmaceu-
The JAMA report, citing data on 200,000 youngsters from different
ticals, makers of Ritalin, of conspiring with the American Psychiatric As-
parts of the country, revealed that the use of stimulants such as Ritalin
sociation to create the "novel medical disorder" of attention deficit
and antidepressants such as Prozac had doubled, in some cases even tri-
hyperactivity disorder (ADHD) in order to make money.
pled, between 1991 and 1995. One important fact was lost: The number
Now, it will be interesting to see how the media cover two upcoming
of preschoolers on those medications was low to begin with.
high-level conferences-one sponsored this week by the Surgeon Gener-
Nonetheless, the story made for provocative headlines and sound
al's Office, the other in October by the Food and Drug Administration
bites, and there was no problem finding experts willing to support the
and National Institute of Mental Health-that will focus on children's
claim that American children-regardless of age-were being overmed-
mental health, treatment and medication.
icated.
Thope we will not see more hyperbole. My experience,
As a clinical psychologist who treats children with
and that of many other therapists, has shown that psycho-
behavioral and emotional problems, I was dismayed
tropic medications can be safe to prescribe and dramat-
by the coverage. I feared that worried parents would
ically effective in children and adolescents. Certainly there
refuse or resist the use of medications that could help
have not yet been enough controlled studies of their use
ILLUSTRATION BY PHILIP BROOKER
and effects over time. But the media stories have greatly
Patricia Dalton, a clinical psychologist,
FOR THE WASHINGTON P.O
practices in the District.
See ALARM, B4, Col. 1
Don't Be Scared About Medicating Our Ch
ALARM, From BI
childhood problems should not be made lightly. The
miserable because of a rift with some boys in his class
costs and benefits must be weighed in each situation.
and was resisting going to school. In general, he com-
oversimplified a complex issue.
But it is an invaluable weapon in the arsenal of treat-
plained constantly, seemed deeply unhappy and had
The truth is that psychotropic medications for chil-
ments available for psychological and emotional prob-
trouble sleeping; he had always been much harder to
dren are both over- and under-prescribed. And the larg-
lems in children.
raise than his sunnier younger sister. Because both his
er of these problems is that there are children and ado-
mother and grandmother had suffered from depression,
lescents who are not getting the medication they need.
T
ake the example of the extremely bright 11-year-
and had been successfully treated with medication, I
Let me be very clear: Medication is not a substitute
old who was brought to my office by his mother
suspected it could work for his mood disorder as well.
for therapy. And the decision to use medication for
and father. The immediate reason was that he was
But his parents were hesitant because of his age. So I
recommended a combination of individual and family
sessions while we observed his progress.
ADVERTISEMENT
ADVERTISEMENT
Over the next four months, the boy went to school
more willingly and seemed to get along better with
friends, but there was no major change in his lack of joie
de vivre or his sleep pattern. One night around bed-
time, he said despairingly to his mother, "Mom, some-
times I don't know what the purpose of my life is." At
this point, I strongly recommended that their son see a
psychopharmacologist, and his parents agreed. Anti-
depressant medication was prescribed, and both his
symptoms and functioning changed dramatically for the
better.
Exposé:
Then there was a 4-year-old boy who was so im-
pulsive and disruptive that he was expelled by two pre-
schools and never invited to play with another child
more than once. When I met him, he was turning the
FOREIGN ASSAULT
household upside down and driving his parents to dis-
traction. With a combination of Ritalin for him and
some child management strategies for his parents, over
a period of weeks he began to corral his behavior, take
turns and relate better to other kids. He reentered
school-this time, successfully. Everyone was happier,
especially the child.
The key word here is "combination."
ON AMERICAN JOBS
There a
Research on adult depression has found
that the use of both therapy and medi-
cation is often more effective than ei-
consequ
ther alone; it seems reasonable that this
finding would apply to children as well.
for failir
The Office of the Surgeon General re-
ports that of the 70 million children and
adolescents in the United States, 6 mil-
treat ch
AND COMPANIES
lion to 9 million have a serious emo-
tional disturbance-and only one in
five of those receives professional help.
adequa
By conservative estimates, 3 to 5 per-
cent of school-age children are affected
by ADHD and 2.5 percent by mood disorder; only 1.2
percent of these children are treated for ADHD and .3
percent for mood disorder. The proportion affected by
depression rises to 8 percent in adolescence, and far
UNCOVERED!
fewer get treatment than need it in this age group as
well.
It is important to note that there is no definitive diag-
nostic test to show the presence or absence of ADHD or
mood disorder in the way an EKG can detect heart
problems. Instead, both are identified through signs,
symptoms and functional impairments. Astute profes-
sionals (and sometimes observant family members) can
identify them with reasonable success. But it's partic-
GLOBAL
ularly difficult with children, because they are usually
less verbal, and harried family practitioners and pedia-
STEEL
tricians often lack the time that careful assessment
TRADE
requires.
The assault is real and America
We depend on safe, strong American
As a result, stimulants, antidepressants and mood
steel every day. In our cars. Buildings.
stabilizers have sometimes been prescribed for children
could lose even more of its world-class
without adequate assessment and follow-up. Even in
steel industry. Over the last two years, the
Highways. And for our national defense.
therapists' offices, medication is sometimes recom-
illegal dumping of foreign steel has
We can start by insisting that
mended when other interventions such as classroom be-
caused companies to go bankrupt and
foreign countries tear down their walls
havior modification programs or family therapy would
have sufficed. Sometimes too much medication is pre-
cost thousands of Americans their jobs.
against American steel imports, and
scribed, or for too long a time. (I suspect that this is
An unprecedented report by the U.S. Department
open their markets. But we also need to strengthen our
more likely in affluent, educated families with high ex-
of Commerce recently said unfair trade practices are
own trade laws and enforce those rules more aggres-
pectations and resources.)
sively - at home and in the World Trade Organization.
This is a problem that should concern us. But I can
the major cause of the U.S. steel market's decline and
tell you about a greater problem: The agony of living
warned that our industry is in jeopardy unless action is
It's time for. Washington to stand up for America.
with mental disorders before there were any drugs to
taken soon.
It's time to insist on fair trade for everyone.
help treat them. The last half-century produced huge
That's bad news for everyone. Because a weak
Stand up for American steel
and for every
strides in the development of effective medications and
therapies. Take depression: In 1950, not one medication
American steel industry means a weaker America.
American industry.
had been identified or developed to treat it. Those suf-
ferers who improved with the rudimentary psychother-
apy of the day usually had a mild form of depression. To-
STAND UP FOR STEEL
day, there are more than 30 antidepressant
medications. When one isn't effective, often another or
The American Steel Industry
a combination of medications will work.
Paid for by STAND UP FOR STEEL D coalition of the leading American steel companies and the hardworking men and women of the United Steelworkers of America.
PHOTOCOPY
PRESERVATION
ildren
In general, with appropriate diagnosis, we can effec-
tively treat 80 to 90 percent of persons with mood dis-
order, and 90 percent of children with ADHD.
to
In spite of these impressive treatment statistics, even
is
today professional help is not always sought or heeded.
n,
There are therapists who do not diagnose with acuity,
I
or, even worse, who take the rigid position that medica-
il.
tion is never indicated for children. It was a shame that
I
children and adolescents suffering from mental dis-
ily
orders did not get appropriate treatment when these
medications were first on the market several decades
bol
ago. But the same failure is a travesty today.
ith
I will never. forget the bright, wistful 33-year-old
pie
woman who came to me some time ago with many prob-
ed-
lems: personal angst, underemployment, divorce and
ne-
few friends. She had vivid memories of being a confi-
At
dent young child who became severely depressed
a
around the age of 10, sitting inside looking out the win-
nti-
dow rather than playing with her friends. She was final-
his
ly properly diagnosed when she was 30, and began get-
the
ting both medication and psychotherapy. (This is not
that unusual; the average time lost between initial
im-
symptoms and diagnosis of a mood disorder is 10
pre-
years.) While her depression lifted and she was able to
hild
make progress in therapy, she was painfully aware of the
the
lost potential that could never be reclaimed.
dis-
I can also remember a 45-year-old professional man
and
with several failed jobs and three marriages. His agita-
over
tion and restlessness, dating back to childhood, were
take
classic signs of ADHD, and the tragedy is that he was
ered
not diagnosed and treated until he was well into middle
pier,
age. He paid a price for this-and so did his wives, chil-
dren and business partners.
re are severe
Each of these cases illustrates a
crucial point: Untreated mental dis-
orders in children have developmen-
sequences
tal ramifications that can last the rest
of their lives. Early treatment is al-
failing to
most always far more effective treat-
ment. The malleability of a child's
brain chemistry and personality di-
children
minishes with the passing of time.
Many problems that we see in adults
quately.
are the result of having been derailed
developmentally during childhood. A
person cannot re-live his youth.
There are reasons for being wary of
dy 1.2
medicating young people. One is the legitimate concern
and .3
regarding safety. There have been very few controlled
ted by
clinical trials of psychotropic medications on children in
nd far
general, and even fewer on preschoolers. Most drugs
oup as
therefore are prescribed for children "off-label," which
means that testing for safety and efficacy has been done
diag-
only with adult populations. Clinical use, however, has
HD or
provided important anecdotal information.
heart
Parents should also be wary of incomplete or inade-
signs,
quate evaluation. Thorough assessment of mental dis-
profes-
orders takes time and diagnostic acumen, in part be-
rs) can
cause symptoms of various disorders can overlap. Some
partic-
agitated children diagnosed with ADHD and treated
usually
with a stimulant actually have bipolar mood disorder,
pedia-
which requires a mood stabilizer. Another common er-
ssment
ror is diagnosing unipolar depression when the child
really has a bipolar disorder, involving both manic and
mood
depressive episodes. If antidepressants alone are pre-
children
scribed, they can precipitate a manic episode.
Even in
Cost, both in terms of money and time, also deters
recom-
proper identification and treatment of these children.
oom be-
Many poor children have either no health care or inade-
would
quate health care. These same children are often in
is
pre-
schools that are so overwhelmed with problems that
this
is
they can hardly educate children, much less identify and
high
ex-
remedy mental disorders. Lack of health insurance and
cost-cutting policies of managed care companies also
I can
mean some children do not'get the treatment they need.
of
living
There are severe consequences for failing to treat
drugs to
children adequately. Prisons are full of poor, learning
huge,
disabled young men who had ADHD that crossed the
and
line into oppositional defiant disorder. Suicide is a prob-
dication
lem reaching epidemic proportions, seen now in chil-
suf-
dren as young as grade school and with increasing num-
chother-
bers in middle school, high school and college,
To-
especially among boys. A diagnosable mental disorder
pressant
is thought to exist in 90 percent of all suicides.
other or
We can make a difference with the judicious use of
drugs. There are children who are counting on it.
PHOTOCOPY
PRESERVATION
(877)
24/- 7-3 1838
Call-