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Are the youngest children in class overmedicated?

Are the youngest children in class overmedicated?

Science News

The Overprescription of Drugs for Children 

The use of drugs has always been a prominent part of American society. However, the extent to which we use pharmaceutical drugs today has surpassed any figure in the past. This is in part due to the mental health crisis that America is in. Americans, especially adolescents, are being prescribed psychoactive drugs by psychiatrists more than ever. However, this is not just because America is following unhealthy behavior.

Through new editions of the DSM, the standardization and expansion of mental illness has caused an increase in the number of people who are considered to have mental illness. Furthermore, the transition from talk to drug therapy has increased the number of prescriptions that are given out by psychiatrists. Along with this, the economic incentivization from third parties has caused psychiatrists to prescribe drugs in cases that are sometimes unnecessary. This is especially true for children, since pediatricians often prescribe medicine that is not meant for them. This can cause serious long term health problems and even death. The psychoactive drug industry has created an industry that focuses too much on money and not enough on the patient. 

The way to treat mental illness has not always been primarily based on drugs.

Adderall 20 mg tablets
A group of 20 mg Adderall tablets, some broken in half, with a lengthwise-folded US dollar bill along the bottom (3.07 inches; 7.8 cm) for size comparison
Image credit: Seppi333 – Own work
An image of a common prescription amphetamine salt formulation. Adderall, with, along the bottom, the edge of a US dollar bill folded in half (3.07 inches; 7.8 cm) for size comparison. This tablet contains salts of both levoamphetamine and dextroamphetamine.

Before the shift to drug therapy, talk therapy was the predominant way of caring for people with mental disorders. However, for psychiatrists, there were many economic incentives for switching to drug therapy. Many psychiatrists become paid on a fee-for-service basis. Meaning they receive compensation for each patient they see, allowing them to make more money simply by seeing more patients. By using drug therapy, psychiatrists became able to see patients more quickly. Thus getting paid more.

Moreover, because of this, “psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients” (Angell). Instead of a lengthy talk therapy session, psychiatrists were able to see up to three times as many patients by accelerating the process through drug prescriptions. Furthermore, some psychiatrists became almost forced to prescribe medicine for their patients. For example, “most psychiatrists were reimbursed for treatment only if it involved prescribing psychotropic medications” (Mayes et al. 88). The incentive to make more money by drug therapy was ubiquitous. There was no encouragement to engage in talk therapy anymore. However, the majority of the money to become made was not in this increase in patients, but in wealthy third parties. 

Pharmaceutical companies, insurance companies, and even the government were willing to pay psychiatrists to prescribe drugs rather than provide talk therapy.

For each type of mental illness, there are a plethora of different psychoactive drugs from different companies that fundamentally do the same thing. They are so similar in fact that one psychiatrist said that, “to a remarkable degree, our choice of medications is subjective, even random” (Angell). It is up to the psychiatrist to make the decision on what drug to prescribe the patient. Because of the leeway psychiatrists are given into what drugs they prescribe, drug manufacturers are willing to pay for their drug to be prescribed over similar drugs. Pharmaceutical companies “marketed their products directly to physicians, who were free to prescribe virtually whatever drugs they wanted” (Mayes et al. 90).

Having their drug take precedence over other drugs would result in larger profits. Whatever money they paid to psychiatrists would pale in comparison to the amount they would make from the exposure of their product. Unlike psychiatrists, other physicians do not have the discretion to choose a drug of their liking. They have to use specific drugs for specific scenarios rather than having a catalog of identical drugs that they can choose from.

Because of this, “psychiatrists were found to receive more money than physicians in any other specialty” (Angell).

The practice of psychiatry is more tainted by outside money than any other medical profession. However, it wasn’t only drug companies paying psychiatrists. Both insurance companies and the government were willing to pay psychiatrists to prescribe drugs instead of talk. There was an “increasing reluctance of insurance companies and the government to reimburse long-term talk therapy” (Mayes et al. 73). Government and insurance companies liked drug therapy more because it was consistent and was what the medical model explained would work. Talk therapy took a long time and was a much bigger investment compared to a quick prescription. Third-party payers were more favorable to drugs therapy which is proven in the better reimbursement rates and the higher insurance coverage. The shift from talk to drug therapy was primarily for economic gain rather than the good of the patient. 

The publication of the DSM-III is another major reason for drug therapy’s increase in prominence and why more people are relying on drugs to help their mental disorders.

The DSM series are books used by psychiatrists to classify a patient’s mental illness. It includes symptoms and characteristics of mental disorders in order to help psychiatrists diagnose what a patient has. However, there was a paradigm shift from the DSM-II to the DSM-III. The later model focused on standardizing mental illness. It wanted to allow that “if 10 psychiatrists saw the same depressed patient separately, all 10 should conclude – based on the patient’s observable symptoms – that the patient had a depressive disorder” (Mayes et al. 75). The DSM-II allowed much more ambiguity in definitions of different mental illnesses and had a much more fluid approach to diagnosis. This standardization of mental disorder was a major reason why more people are not only diagnosed, but also medicated.

The DSM-III “was an important factor in bringing about what has been referred to as the ‘remedicalization’ of American psychiatry” (Mayes et al. 71).

This, along with the economic incentives, is a major reason as to why psychiatrists switched from talk to drug therapy. The DSM-III caused more people to be diagnosed with mental illnesses due to the greater number of mental illnesses that were now categorized.

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1952 edition of the DSM (DSM-1)
 https://www.washington.edu/news/2014/03/28/documents-that-changed-the-world-mental-disorder-diagnostic-manual-1952/

Since the DSM is the primary source that psychiatrists use in order to diagnose mental illness, the more that are in the book, the more people that will fall under those categories. This was true with children in particular since “the number of pages devoted to childhood and adolescent categories increased from two in the DSM-II to 65 in the DSM-III” (Mayes et al. 79). By simply adding more disorders, they increase the number of people that fall under the category of mental illness, even if they might not have before. 

By adding more types of mental illness, the writers of the DSM are categorizing more behaviors as mental illness.

With each following issue of the DSM, the number of pages and therefore mental illnesses has increased. Behavior that would seem normal in the past may now be considered an illness due to it being put in the DSM. Things such as “normal family conflicts, childhood misbehaviors, and variations in temperament are medicalized” (Cohen et al. 1886).

As more and more behavior is now considered disorderly, more and more people are recommended to go to the psychiatrist. This is especially true in children where psychoactive drug ads will be placed for parents to see. The ads will promote a medicine in order to help a child that is depicted to have anxiety or any other common mental disorder. However, these ads will be portraying a situation that would normally be anxiety causing such as moving homes or going to college. For instance, in the American Journal of Diseases of Children, an ad says, “A child can usually deal with his anxieties. But sometimes the anxieties overpower the child. Then he needs your help. Your help may include Vistaril” (Lennard et al. 439).

This ad depicted a child going to school, a normal anxiety provoking event.

However, due to the expansion of the DSM, this anxiety is now recommended to get medicated. This results in parents that do not want their children to be anxious turning to drug treatment. In turn, the number of kids that are medicated has increased. About “seven percent of boys and five percent of girls under the age of 19 in the USA are taking a psychotropic medication, often in multi-drug combinations” (Cohen et al. 1886). The amount of children that are considered to have a mental illness has increased due to DSM and the expansion of the definition on what it means to be mentally ill. The switch from talk to drug therapy has affected the nation’s youth heavily and has resulted in them taking more prescription psychiatric medication than ever before. 

The number of people with mental disorders in general has increased drastically.

This is especially true with children. There has been a “ thirty-five-fold increase” for children with mental disorders (Angell). This is a much larger increase than any other groups of individuals.

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The prevalence of mental illness is higher in more economically unequal countries
The Spirit Level, Wilkinson & Pickett, Penguin 2009.
The Spirit Level: Why More Equal Societies Almost Always Do Better.

This is in part due to the increase of mental disorders in the DSM, but also because of the increase in parents bringing their children to mental health resources. In recent times, both parents are now working resulting in children being home without parental supervision. However, without the parents home the children act out more and become more disobedient. Both of the parents, undertaking the stress of work, have less patience for this disobedience resulting in a “decreased tolerance for behaviors in children that are considered disruptive” (Mayes et al. 84).

This in turn makes the parents more willing to go to the psychiatrist in order to make their child more obedient, even though it is a very normal behavior. This is not the only thing that persuades parents to bring their children to the psychiatrist. Supplemental Security Income (SSI) payments have become a significant source of income for some families. For example, a “family’s total income from SSI was about $30,000 per year” (Angell).

This large sum of money is enticing to some families that are typically poorer. Along with this, qualifying for SSI ensures that one will also qualify for Medicaid.

These benefits cause some parents to take their children to psychiatrists for things that they would not usually go for. It was shown that “children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines” (Angell). Parental influence greatly affects the type of treatment that their children receive. Whether it be stress from work or the benefits from SSI, children are more likely to receive psychiatric care than ever before. 

The reliance on psychoactive drugs further facilitates the usage of those same drugs. Drugs alone are not as effective as talk therapy. They only serve as a temporary fix for the disorders that these children are perceived to have. Compared to talk therapy, “the drugs do not… reach the sources of the anxiety or misery” (Lennard et al. 440). This results in the children having disorders for longer periods and going to the psychiatrist more often. They have to stay on the drugs for longer amounts of time because of this. Before the shift to drug therapy, a minority of children received prescription drugs to help their problems.

Only “about a quarter (28%) of the children diagnosed with ADHD in 1980 were prescribed stimulants, whereas the vast majority (86%) of them were by 1990” (Mayes et al. 71). The shift from talk to drug therapy has caused a majority of children who are diagnosed with mental illness to rely on drugs which in the end is only a temporary fix. This demonstrates the drastic shift to the reliance on drugs by psychiatrists despite it only working for the short term. 

This shift to medication is detrimental to the children because it can have a profound impact on a child’s developing brain!

Additionally, it can have lasting effects on their mental and emotional health. Sometimes drugs are even prescribed to infants despite never being tested for children that young. A big problem with being prescribed psychoactive drugs is that “even a highly selective drug is likely to react with some structure other than the one which it has been designed” (Lennard et al. 439).

Moreover, even a specialized drug that is only supposed to focus on one aspect of the human anatomy is going to affect something else. This results in unwanted side effects that have to be treated with other drugs. This in turn creates a snowball effect resulting in the patient oftentimes taking “as many as six psychoactive drugs daily” (Angell). The diversity and amount of drugs that the average patient takes results in more economic profit for the pharmaceutical companies. 

The nature of psychoactive drugs requires many patients to take multiple drugs.

This may be fine in adults, but for children this can be especially dangerous. Oftentimes, the child is prescribed medicine that is not even tested for people of their age. The overprescription of psychoactive drugs results in more children requiring to take an amalgamation of medicine that was never meant for them. There are often very serious side effects because “these children are often treated with drugs that were never approved by the FDA for use in this age group” (Angell). Because children aren’t tested, the side effects that are known are often exaggerated or have even worse long term effects. The effects of Zyprexa, a drug used to treat Bipolar disorder, include rise in blood sugar, cholesterol, emotional disengagement, and diabetes.

However, for children and teenagers, they “become diabetic in fairly short order” (Angell).

The side effects of this drug affect children much worse than adults. Along with this, for both adults and children, they would have to take other drugs to counteract the side effects of Zyprexa. However, for children they would most likely have to take drugs that again are not tested for them which just repeats the original problem. These drugs should not be allowed to be given to children, but they are in higher quantities than ever before. This is only able to happen because of something called off label prescription. Psychiatrists can prescribe medicine not originally intended for children if they believe it is in their best interest.

However, “conflicts of interests in the research enterprise mislead providers and consumers about drug effects” (Cohen et al. 1886).

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Eight patients representing mental diagnoses as of the 19th century at the Salpêtrière, Paris.

Pharmaceutical companies will still pay psychiatrists to recommend their drug to children even while knowing it hasn’t been tested.

This is one of the major flaws and consequences of the psychiatric practice controlled by pharmaceutical companies. Children can become severely injured for life, or even die. For example, “a four-year-old child named Rebecca Riley died in a small town near Boston from a combination of Clonidine and Depakote, which she had become prescribed” (Angell). Like many other children taking psychoactive medications, Rebecca was taking more than one type. Pharmaceutical companies and psychiatrists overlook the danger to children in order to make more money even if the danger includes death. The “study of potential harm to the child’s developing brain and emotions becomes neglected by responsible authorities” (Cohen et al. 1886). They don’t care about what happens to patients, they only care about the money they make off of them. 

The growth of mental illness in America is caused by the expansion and standardization of mental illness. With each new edition of the DSM, the number of mental illnesses increases leading to more normal behavior being considered a disorder. This along with the shift from talk to drug therapy is what has caused the increase in use of psychoactive drugs. Economic incentives further increase the amount of prescriptions that are written by psychiatrists.

In conclusion, government and insurance companies primarily compensate for drug therapy while pharmaceutical companies directly pay psychiatrists to prescribe their drug. The consequence is not only an increase in unnecessary prescription, but also the wrongful prescription to children. This results in harmful lasting side effects that can even result in death.

The mental health epidemic in America is not caused by Americans getting sicker, but by the psychiatric and pharmaceutical industry making us believe we are.

Are the youngest children in class overmedicated? Written by Jonah Luetke

Works Cited 

Angell, Marcia. 2011a. “The Epidemic of Mental Illness: Why? | Marcia Angell.” NY Books, 2011. 

https://www-nybooks-com.amherst.idm.oclc.org/articles/2011/06/23/epidemic-mental-illness-why/. 

Angell, Marcia. 2011b. “The Illusions of Psychiatry | Marcia Angell.” NY Books, 2011. https://www-nybooks-com.amherst.idm.oclc.org/articles/2011/07/14/illusions-of-psychiatry/. Cohen, David, et al. “American Parents’ Willingness to Prescribe Psychoactive Drugs to Children: A Test of Cultural Mediators.” Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, vol. 48, no. 12, Dec. 2013, pp. 1873–87. EBSCOhost, 

https://doi.org/10.1007/s00127-013-0710-2.

Lennard, Henry L., et al. “Hazards Implicit in Prescribing Psychoactive Drugs.” Science, vol. 169, no. 3944, July 1970, pp. 438–41. EBSCOhost, 

https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=edsjsr&AN=edsjsr.1 730250&site=eds-live&scope=site. 

Mayes, Rick, et al. “The Transformation of Mental Disorders in the 1980s: The DSM-III, Managed Care, and ‘Cosmetic Psychopharmacology.’” Medicating Children: ADHD and Pediatric Mental Health, Harvard University Press, 2009, pp. 70–95. JSTOR, https://doi.org/10.2307/j.ctv228vqx9.7. Accessed 13 Dec. 2022.