Written By: David Greisman
When it comes to the question of whether children are being overmedicated, Carroll County specialists Tom Zirpoli and Dr. Miguel Macaoay say the numbers speak for themselves. It’s just that they, and others, disagree about what those numbers mean.
Macaoay, the medical director of behavioral health services and chief of psychiatry at Carroll Hospital Center, points out that just as the number of kids with other medical conditions is increasing, so too are the diagnoses of youth with mental health issues. Medication can be an important tool for treating them, he says.
“Early assessment, identification and intervention is crucial,” Macaoay said. “These are young people that have everything at stake: their academics when they’re school age, and what happens in young adulthood in terms of employment and college. We’re looking at crucial stages of development that can have a serious impact on their futures.”
Zirpoli is an education professor at McDaniel College who coordinates the school’s graduate program in human services management. He also holds McDaniel’s endowed chair in special education and heads up Target Community and Educational Services, which works with hundreds of kids and adults with developmental disabilities in Carroll and Montgomery counties.
“I think all the psychotropic medications are overly used, because it’s frequently easier to prescribe a medication than it is to prescribe a treatment,” said Zirpoli. “They’re being prescribed not as a support, but as a substitute for good behavior management. Medication is just the bandage. In the long term, kids still end up not having social skills, and that follows them for the rest of their lives. They have trouble finding jobs, holding down a job and staying in college because the fundamental issue of managing their behavior has not been taught to them.”
Zirpoli believes that sometimes doctors will issue prescriptions for kids too easily, or that parents will doctor-shop until they find someone who will give the medication, resorting to that as a method for handling a child’s inappropriate behavior.
He is not alone in this belief. An article in an October 2012 edition of The New York Times related the story of one doctor in Georgia who prescribes a drug typically used to treat those with attention deficit hyperactivity disorder, but does so in an attempt to boost the performance of poor students in poor schools.
Meanwhile, psychologist and Duke professor Keith Conners said in The Times in December 2013 that the massive rise in the number of children diagnosed with A.D.H.D. was not an epidemic, but rather “a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
Zirpoli contrasts the percentage of A.D.H.D.-diagnosed children with those who have other disabilities. About 10 percent of school-age kids in the United States have learning or physical disabilities, health impairments, hearing or vision problems, autism or other developmental disabilities.
“Yet A.D.D./A.D.H.D. supposedly affects between 14 and 18 percent of children,” said Zirpoli. “That’s more evidence that the A.D.D./A.D.H.D. label is overused, and so is related medication. It’s gotten totally out of control. It’s a billion-dollar industry for the pharmaceutical companies.”
Carroll Hospital Center’s Macaoay says there may be some children who are being overmedicated, or are receiving prescriptions from primary care providers who may not have the time or training to offer a full assessment. But, he says, the majority of kids are not overmedicated. And in fact, there are many youths who should be receiving treatments for mental health issues, such as therapy alone or therapy combined with medication, but are not.
“One in four parents has difficulty finding mental health services for their child,” Macaoay said. “Waiting to see a mental health professional can take three months to a year. There is effective treatment. Unfortunately, there’s a delay between the onset of symptoms and intervention. That is a significant amount of time in a child’s development.”
As of 2011, more than 17 percent of kids with A.D.H.D. were neither being medicated nor undergoing counseling, according to the Centers for Disease Control and Prevention.
“In my county, I see that up close and personal,” Macaoay said. “I see patients who have overdosed or have lived a lot of their adult years suffering with untreated depression or untreated A.D.H.D.”
Thomas Insel, director of the National Institute of Mental Health, wrote in the institute’s website about the perception regarding the large increases in the number of children diagnosed with emotional or behavioral issues and treated with prescription drugs.
“A common interpretation: children with behavioral or emotional problems are being overmedicated by psychiatrists too busy to provide therapy, at the request of parents too busy to provide a healthy home environment,” Insel wrote. Part of that interpretation, he said, could be “to blame schools too busy to provide recess or activities for fidgety boys. And usually the blame extends to the pharmaceutical companies that market medications in pursuit of profits.”
However, Insel said, the rising numbers are possibly “not the problem, but a symptom.”
Yes, there may be some kids whose issues “could be resolved by psychotherapy alone,” but instead are being medicated, he said. But Insel says the rising numbers might indicate that children who once were not being diagnosed are now being treated, or that there possibly “is a real increase in the number of children suffering with severe emotional problems, just as there is a real increase in the number of children with diabetes and food allergies.”
Macaoay says he believes the medical field, by and large, is not prescribing medication to children inappropriately.
“We’re really making a concerted effort to relieve the pain and suffering from serious mental illness in our pediatric population,” he said, “and to hopefully direct them to a path where they can have a more meaningful future.”
