It seems that the prevalence of childhood mental disorders has been increasing in the past ten to fifteen years. Experts are unsure if this is due to the fact that we know more about childhood disorders and more parents are seeking treatment for their children than ever before, if the occurrence of these disorders in children is increasing, if it is a combination of these two factors or if there is an entirely different explanation altogether.
When considering medication for their children, parents generally fall on a continuum of concern and willingness. On one end, we have parents who are dead set against medicating their children even when there is plenty of evidence to indicate that the child may benefit from psychopharmacological intervention. On the other end, we have parents who are so fed up with their children’s behaviors and either don’t have the skills or the patience to enact behavioral interventions and thus want medication for their children immediately so that the parents can get some peace. Then, we have all the people in the middle: those who after trying behavioral interventions with their children for a period of time without achieving acceptable results finally decide that medication may be useful in helping the child overcome some of his or her difficulties, those who are willing to try medication while continuing to work diligently using behavioral interventions with their children to get the best possible results and those who maybe can’t be bothered to follow through with the behavioral interventions but for whose children medication provides some stabilizing effect.
Choosing to place children on medication for emotional or behavioral problems can be a scary thing for parents. We don’t know what side effects our child is going to experience, we don’t know if the medication is going to help or make things worse, we don’t know if the doctor we are consulting with has expertise or not, and the medical profession does not know the long term effects of early psychopharmacologic intervention, especially how these types of drugs affect developing brains. However, sometimes we have no choice. If our child is doing very poorly in the academic setting because he can’t pay attention or is too hyper to sit still, and a medication can remedy this problem, we are likely to try the medication because we know that our child’s education is extremely important to his or her long term success. If our child is having extreme mood swings where he or she goes from happy, hyper and doing risky things to down, depressed and feeling suicidal, of course we would want to intervene pharmacologically to help stabilize his or her moods. In these types of cases, there is almost no question as to whether these children should try appropriate medications.
The place where psychopharmacological treatment becomes sticky business is when parents who are ill-equipped to raise their children, lack necessary parenting skills and don’t know how to set up behavioral interventions for their children foist these problems onto the child, call the resulting behavioral problems psychopathology and demand medication to fix the problems. In these instances, it is likely that overmedication is occurring. If we fail to teach our children from a young age how to behave appropriately, how to self-regulate when they get upset, how to tolerate frustration and how to get their needs met in acceptable ways, they are going to have behavioral problems. And, these problems are not going to be fixed by a pill. However, many parents would like to believe that there is a magic pill to fix all of the things that they have failed to teach their children. For whatever reason, these parents are unable or unwilling to learn effective ways of intervening in their child’s problem behaviors and want the psychiatrist to fix the problems by giving the child a pill.
Some parents can be very convincing in stating their cases for why their children need medication. Psychiatrists are often able to discern what is a parenting problem and what is an organic problem within the child, but not always. Some of the subtleties slip through the cracks, and we end up with children who are being medicated but for whom medication is ineffective. This is where overmedication can occur.
Increasing efforts in parental education and the provision of family therapy interventions has helped to assuage the problem of overmedication to some extent. However, overmedication is likely to continue occurring in some cases.