Six-year-old Johnny headbutts his grandma, throws fits in school and terrorizes other children. Is he the degenerate spawn of incompetent parents - or in desperate need of meds?
Judith Warner, a journalist and vociferous critic of hyperparenting, says she was convinced that parents were latching on to "fashionable" diagnoses such as oppositional defiant disorder instead of disciplining their kids.
But her hunch didn't prepare her for the agonizing truth, the author explains in We've Got Issues: Children and Parents in the Age of Medication.
This book was supposed to be an exposé of overmedicated children. Why do you now believe that childhood mental illness is underdiagnosed?
I started to do some research and not just rely on my preconceptions and prejudices and the factoids that I had put together from the media. When I started to speak to doctors, including doctors who I had specifically chosen to interview because I thought they shared my point of view, I heard that overmedication and overdiagnosis were really not the major problems. The major problem was underdiagnosis and undertreatment, especially of children from poor or minority backgrounds.
Where did we get the idea that affluent parents were feeding their children psychiatric pills like candy?
I think that we are just primed right now to think the absolute worst of parents, and of affluent parents in particular. And we are surrounded by examples of obnoxious parenting - of parents being very competitive and trying to get every possible advantage for their children. So it was very easy to assume that what was going on with children and [mental]diagnoses and medication - which is a new concept to most of us - was another aspect of this general parenting culture.
How do you explain the skyrocketing rates of ADHD, autism and bipolar disorder in recent decades?
We didn't have these diagnoses before, or not as such. Large numbers of children in the past were diagnosed as mentally retarded and some of the children who are now diagnosed as autistic would have been called schizophrenic. There was no diagnosis of attention deficit disorder before 1980. It wasn't believed that children could suffer from depression until the 1970s, or that anyone other than young adults could have bipolar disorder until the 1990s. So, basically, you have huge increases because you went from nothing to something.
Are we pathologizing what used to be considered personality quirks?
That is the big criticism that comes up all the time. And that perception rests on ignorance and a lack of understanding that what these kids are going through is very serious and often very painful. There are real differences in degree between the kind of distress or unhappiness or inability to stay focused that average kids experience because it's just part of life, and what kids who end up getting diagnosed and treated suffer from.
Your research suggests that, in fact, parents will do anything to avoid medicating their kids. Why?
Nobody wants to medicate their child. They do not want to put chemicals in their children's bodies. I did not encounter a single person who did not feel this way. People are afraid of what these drugs are going to do to their kids' brains, what the side effects are going to be and whether it's the right decision. It's a very painful thing.
Which alternative therapies do parents pursue - and is there evidence they work?
It's anything from removing sugar, food dyes and preservatives from the diet to biofeedback, vision therapy, yoga and martial arts. Some of these things can help kids … [but]there isn't any proof that any of these things can be a real substitute for more traditional and mainstream forms of treatment.
Evidence of safety and efficacy for certain psychiatric drugs prescribed to youth is lacking as well. So what is the argument for medicating children?
I think that most doctors feel there is a strong enough basis in the science to feel comfortable to move ahead. That's why it's so crucial for parents to have a pediatrician they can trust, who can start out as the medical home for a child and then steer the parents towards other good professionals who can help them. And it isn't true that all the research is bad.
What about the spectre of Big Pharma and reports of pill pushing by psychiatrists on the take?
What's happened with Big Pharma is a scandal which has grotesquely tarnished the reputation of psychiatry and is going to take a very long time for psychiatry to recover from. Things have happened that are just unacceptable. For now, I think that parents are safest trying to get their information from sources that are not tainted with drug money. In America, at least, the National Institute of Mental Health has very good pages on its website about children's mental health disorders and different treatments that are considered scientifically valid.
What is the case for treating mental illness in a five- or six-year-old rather than waiting to see if the problems will resolve themselves?
I think that most doctors really do try to wait with children that young before they diagnose something, unless the case is so severe and the problems are so great that there is an absolute urgency to do something. With school-aged children, the argument is that not giving children help is risky as well. Mental illness is actually bad for the brain. And it sets you up for having all kinds of negative experiences that then impact your personality and your brain further.
Why are we so contemptuous of parents who medicate children at risk of suicide or harming others?
I think it's just a really deep-seated prejudice that we've had for so long - that if you deal with something chemically, you're taking the easy way out: You're not grappling with the true issues that have happened to the child [like]family problems, family pathologies. [But]with so many disorders, there isn't anything terrible going on in the family … parents don't single-handedly cause mental illness.