The Myth of Overmedication

We’ve Got Issues: Children and Parents in the Age of Medication
By Judith Warner
Riverhead Books. 320pp. ISBN: 9781594487545

The best way to read We’ve Got Issues: Children and Parents in the Age of Medication is to think of it as the education of its journalist author, Judith Warner.

From the get-go, she confesses that when she first set out to write her book, she was certain that large numbers of American children were being overmedicated and unnecessarily pathologized by their neurotic and competitive parents. She doubted the supposed seriousness of the wide array of elusive-sounding mental health ailments, behavioral problems, and learning disabilities from which these children were said to suffer. The whole thing sounded like a scam, ripe for an expose.

The book she initially proposed to write would put the blame where she felt it belonged—on overanxious parents, who inflated and overdramatized their kids’ problems into major issues, and then fed them Ritalin or antidepressants as the easy way out of parental responsibility. It didn’t matter that, in fact, Warner didn’t know any such parents or families. Nevertheless, wherever she went in her upscale urban milieu, she heard anonymous anecdotes that seemed to confirm this deplorable trend. As the author of a previous bestseller about the stressed-out lives of contemporary families, Perfect Madness: Motherhood in the Age of Anxiety, Warner sensed a story that might make a good follow-up to her earlier publishing success. She had no trouble getting a lucrative contract based on nothing more than her casual assumptions and a conversation with her editor.

Only then did she actually begin to research her thesis. To her chagrin, the picture that emerged was not only quite different, but far more complex than the simplistic notions with which she’d begun.

First, despite public perceptions to the contrary, reliable statistics purporting to prove that vast numbers of children are incorrectly diagnosed with and improperly medicated for disorders— ranging from AD/HD to autism to depression and bipolar disorder—just don’t exist. Rather than well-designed epidemiological research that could provide solid answers to the current state of our children’s mental health, Warner found numerous inconclusive, confusing, and often conflicting reports, whose various findings can be selectively cherry-picked to support a bewildering range of preconceived conclusions. In fact, she concluded that, “For every researcher who believes there has been a real increase in a certain mental disorder, there is another one saying that, in fact, there hasn’t.”

Whom to believe—or even what to believe? Perhaps the most balanced perspective on the incidence of at least one mental disorder—depression—came from Duke University epidemiologist E. Jane Costello, who concluded from a research study that encompassed 60,000 adults and children that, “Thirty years of research suggests that, for as far back as we have reliable assessments, a similar proportion of children have been depressed, albeit, largely unrecognized by clinicians. If more depressed children are being identified, or are receiving antidepressant medication, this is more likely to be the result of increased sensitivity to a long-standing problem than of an Ôepidemic.'”

And yet “increased sensitivity” is itself a buzzword for those claiming that’s the cause of any number of wrongly diagnosed cases or findings of disorders that may not even exist. Rather than wasting energy debating the numbers, Warner asks, wouldn’t the public (and our children) be better served by training pediatricians and therapists more thoroughly, so they can identify the correct diagnosis, and provide suffering children with the help they require?

And countless children are suffering, especially those who are poor or disadvantaged. For instance, up to 60 percent of foster care children have mental disorders, she found. Moreover, after reviewing the evidence, Warner was surprised to find herself concluding that neither they—nor children in general—are being overmedicated. According to U.S. government statistics, while 5 to 20 percent of all children have psychiatric problems, only 5 percent take psychotropic medications. That’s hardly the “pattern of gross overmedication” that’s believed to exist by a vast majority (86 percent according to one survey) of the American public.

Bottom line: the trend Warner’s research uncovered is that it isn’t that too many children are diagnosed with fake psychiatric ailments, but that too few children and adolescents (only 30 percent, according to one source) are receiving the help they require to cope with very real mental health ailments—disorders that, left untreated, have the power to impair their psychological, educational, social, and medical well-being. Far from being “bad” parents who’d rather push a pill than spend time with their kids, the mothers and fathers Warner spoke to devoted most of their time (and money) trying to find treatments that worked and battling for aid from budget-strapped healthcare and educational systems. Further, they almost always viewed psychotropic medications as a last (not first) resort, a necessary stabilizer that would allow their kids to benefit from other kinds of therapy and enjoy a more normal life. She was even told point-blank by psychologist and AD/HD authority Edward Hallowell: “I don’t know who these parents are, these lazy neglectful parents. . . . I’ve not met them. I think they’re a fiction. I see parents who are working full-time and also trying to do their best for their children.”

These observations were revelations for Warner. Her “aha” moment also led to self-reflection. She wondered: how could she have been so easily duped into believing the myths and stereotypes she’d been served up by sensationalized media reports and playground parents who were as ill-informed as she? Why had she so readily accepted these assumptions at face value—a cardinal sin for any skeptical journalist worth her salt? And how many other people were suffering from similar misconceptions?

That’s when she decided to recast her initial premise and present instead an investigation of the complex realities that contradict the simplistic myths she herself had fallen for. At the same time, she would explore why so many people would prefer not to question those myths. Instead of an exposŽ, her book would serve as a necessary corrective to the public’s (and her own) misperceptions. The particular message to parents, as well as to caregivers and public health policymakers would be: look at the actual psychological and psychiatric issues affecting each child. Don’t rule out the use of medications altogether just because they’re medications. Rather, just as you would with any other type of behavioral or psychological therapy, examine carefully and judge case by case which treatments—alone, or in conjunction with others—are successful, and which ones less so. Most important, make the priority helping the children, not getting lost in polemics.

The result is an honest and important (even if repetitive and meandering) examination not only of the actual mental health “issues” or problems from which many children suffer, but of the deep undercurrent of societal and cultural “issues” that keep so many of us from acknowledging the seriousness of this situation. Indeed, Warner’s own experience of having her assumptions turned inside out allows her to deftly reframe whose issues are getting in the way of meeting the real needs of children in psychological distress.

Our own, of course. “There’s a lot of hot air circulating on the topic of children’s mental health, and what the often outsized vitriol makes clear is that the passion is ideological and only tangentially about real children,” Warner writes. Instead, it’s about culture wars and our own anxieties. Unfortunately, those tangential arguments deflect us from facing the far more important issue: how to raise public awareness that problems rooted in the biology of the brain require resources that go beyond even the most caring parents? How to change public funding to support the educational and psychological needs of these children?

Warner waxes indignant—and at length—that as a nation we do so little for our children. But when it comes to solutions, she has less to say. That’s too bad because her final chapter puts forward an action plan that I would’ve liked to have seen fleshed out. She recommends healthcare policies that emphasize early care; that the government disseminate reliable research on treatments that do and don’t work; that medical schools train and recruit more specialists in childhood behavioral and psychiatric issues; that we as citizens unite to support legislation that regulates advertising for direct-to-consumer medications; that we work together to reframe the discussion of children’s “issues” as one about illnesses that require treatment, as opposed to moralistically judging bad kids and bad parents. Most of all: that we find treatments specific to the ailment, not to a particular ideology.

Such was the education of Judith Warner—and for many readers, her book will prove to be an education as well.