Psychotherapy and Training Collective of New York

The Use of Atypical Antipsychotics in Children

By Brigitte E. Lifschitz, LCSW

I recently read an article in the "Public Citizen Health Letter", April 2013. It talked about the off-label use of antipsychotic drugs in children. The most common use of these drugs was for ADHD and depression.There have been a number of studies researching the use of these drugs in children, and the result has been that these atypical antipsychotic drugs were not found to be effective for any off-use in children. In addition, they were shown to have a number of side effects that can be serious, such as weight gain and an increase in cholesterol levels. In the past few years, there has been a sudden increase in the diagnosis of ADHD and bipolar disorders. Have the numbers increased or is there a wave of overdiagnosis and overtreatment within the medical establishment?

The article goes on to say that children living in poverty, in a single parent or a foster home were much more likely to be diagnosed with ADHD or a learning disability. It should come as no surprise that a child living in poverty or with an overworked or absent parent might have difficulty concentrating in school or tend to misbehave as a result of the circumstances that child lives in.

With many more children being diagnosed with a mental illness, a market has been created for the manufacturers of atypical antipsychotics, and there is much more pressure on doctors to prescribe these drugs. Children who used to be characterized as rambunctious or transitionally sad, are now regarded as mentally ill and treated with medications for years, until adulthood or in some cases for the rest of their lives. Sometimes stressed parents look for an immediate answer to their child's misbehavior and turn to drugs instead of looking at family problems.

The article ends stating that all these factors have led to millions of children receiving risky antipsychotic medications that have not been shown to provide any benefit to them. A medical system that encourages overdiagnosis combined with a persistent marketing campaign that encourages unnecessary use of these drugs will divert attention from long-term social interventions and economic policies that would be of much greater assistance to these young children and adolescents.

I recently had the occasion to witness this very situation when I interviewed a family with two daughters. The older one, who was 14 years old, was failing her classes, getting into physical fights at school and suffering from ongoing depression. The parents had little or no understanding of why this was happening. They were hoping that the right medication would solve the problem. The family was extremely dysfunctional and lacked awareness that their own behavior and lack of good coping skills were contributing to their daughter's belligerence at school and her depression. Their daughter was extremely intelligent but had no tools other than fighting to cope with upsetting situations. She suffered from ongoing depression because of the belief that no matter how hard she worked, she was never going to be good enough. This belief led to her feelings of hopelessness and failure at school. This young girl expected to fail, therefore she put little or no effort into her class work. It was not clear if she would be able to graduate high school.

This young girl had been given a diagnosis of Bi-Polar Disorder and put on medication. Now she had a mental illness label on top of everything else. In the short time that I was able to work with this family, I saw the 14 year old privately with the whole family taking part in the therapy every few weeks. It became clear to me that this girl was highly intelligent but believed that she nothing she did would be good enough. Therefore, she expected to fail at school. This was a result of the way her father treated her. He had no idea of the impact his very critical words had on her. Her father thought that fighting back was the way to handle problems at school. The girl's mother had a learning deficit and could not handle the stress at home or at school. She was not able to handle the tension between her daughter and the father.

My main goal was to help the family find better ways of listening and communicating with each other. I wanted to help them learn more constructive ways to cope with anger, stress, disappointments and disagreements. The 14 year old daughter was really not the problem, it was the parent's inability to listen, communicate or to cope well with everyday problems that led to their daughter's anger, depression and feelings of failure. As far as I was concerned, the young girl did not need medication. Her mood swings were justifiable and the result of being part of a very dysfunctional family. Psychotherapy, not medication, was the kind of treatment that this family needed for all of them to function more productively.