Think Kids Are “Overmedicated”? First Consider This.

By Kaitlin Bell Barnett

I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.

How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?

Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.

A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.

Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.

Among Kids With Diagnosable Disorders, Low Rates of Recent Medication Use

The study, which was published online in the Archives of Pediatrics and Adolescent Medicine, surveyed a large, nationally representative sample of more than 10,000 teens ages 13 to 18.

It found that about 14 percent of kids with DSM-IV psychiatric diagnoses had been treated with medication in the past year.

The percentage ranged widely, however, depending on the condition. Thirty-one percent of teens with diagnosable ADHD reported having taken medication for that condition in the past 12 months, compared to just 11 percent of those with anxiety disorders.

Researchers Find ‘No Compelling Evidence’ For Overmedication

The research team – which includes several major figures in this field – considered these percentages to be reasonable, especially considering the amount of distress and dysfunction involved in the kids they surveyed. “There was no compelling evidence for either misuse or overuse of psychotropic medications,” they wrote.

“The majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings,” they added, “had a mental disorder with severe consequences… functional impairment, suicidality, or associated behavioral and developmental difficulties.”

The study also found that most kids were taking a medication commonly prescribed for their diagnosis, such as antidepressants for depression, or stimulants for ADHD.

Antipsychotic use, which has been growing dramatically in recent years and is the subject of much debate about alleged overprescribing, was very low overall, ranging from 0.1 percent of those with anxiety as their primary diagnosis to 2 percent of those with developmental disorders as their primary problem.

Moreover, just 2.5 percent of kids who didn’t qualify for a psychiatric diagnosis reported having taken meds in the past year.

But even this small percentage of kids who didn’t meet the formal criteria sufficient for a diagnosis at the time they were surveyed weren’t necessarily inappropriately mediated: 78 percent reported having a prior mental or developmental disorder (like autism) that caused distress or impairment.

What’s Missing From The Study

It’s important to note that this study collected data between 2001 and 2004, so it’s possible medication use in teens – or at least the use of certain medications, like antipsychotics – has expanded since then.

And an important measurement was missing from the article that would provide key context about under- or over-treatment. Although researchers queried teens and families about where they received mental health services (in school, from a general practitioner, a mental health specialist, etc.), the text of the article didn’t indicate what percentage of the medicated kids were also receiving other services, such as psychotherapy. It also didn’t indicate what percentage of the unmedicated kids were receiving other services.

That’s crucial, because medication isn’t the only treatment out there. Other therapies have been shown to be effective, and a number of studies have found combined therapy and medication to be superior to either treatment alone.

Therefore, the issue isn’t so much what percentage of kids are taking medications – or even what percentage of kids with a bona fide diagnosis are taking them, the focus of this study.

Rather, the more salient questions are whether kids with troubling emotional and behavioral problems have appropriate and sufficient access to treatment, and whether they and their families consider that treatment – and those who administer it – adequate and effective.

An editorial accompanying the article made that point convincingly.

The editorial also pointed out that this study included a relatively high percentage of well-off kids with private insurance, which might account for the low rates of medication use. Previous studies have shown that kids with public insurance, especially foster children, are far more likely to be medicated at higher rates.

So What Do We Still Need To Know?

Although this study provides valuable information showing that relatively few teens take medication for their psychiatric disorders, we need a study that examines how common psychiatric diagnoses, medication use and other treatment modalities are in youngsters from diverse backgrounds.

And that same study should also measure kids and families’ opinions about access to and effectiveness of different kinds of treatment, as well as their level of satisfaction with the medical and with mental health professionals who administer it.