Update on the Medicated Child and the Evolution of Child Mental Health Treatment | FIRST LINE

When Jessica Kennedy was five years old, she was diagnosed with bipolar disorder. Her mother told FRONTLINE in the 2008 documentary The medicated child that he couldn’t go a day without taking medication to stabilize his mood.

As long as I’m on medication, I’ll be fine, Kennedy told FRONTLINE when she was 12. It’s the only way to keep me settled. Taking my meds makes me calmer, more like I should be.

Now 28, Kennedy has been off psychiatric drugs for a decade. He said that although they seemed to solve his behavioral problems because he was more compliant, his performance in school suffered and his ideas about him became more lucid once he stopped taking them. Therapy now helps Kennedy deal with what her therapist thinks are symptoms of autism.

The meds were literally dulling all my emotions to the point where they didn’t solve the problem, she told FRONTLINE in a recent interview. I still had them, but I couldn’t express them.

The medicated child documented the increase in diagnoses of bipolar disorder among children from the mid-1990s to the late 2000s. This occurred in tandem with an increase in the prescription of antipsychotic drugs to treat them, despite the lack of independent research at the time on the their safety and efficacy in children. Since then, studies have found that children’s prescriptions for these powerful drugs have decreased, and fewer children are taking them for bipolar disorder. However, experts remain concerned about the lack of access to care beyond medicines amid a worsening mental health crisis for young people.

Diagnosis change and antipsychotic prescriptions decrease

By the mid-2000s, increasing numbers of children were being diagnosed with bipolar disorder, a controversial trend since the disorder was previously thought to exist only in adults.

That increase followed a series of studies at Massachusetts General Hospital led by Dr. Joseph Biederman. In a landmark 1996 paper, Biedermans’ group theorized that many children diagnosed with attention-deficit/hyperactivity disorder (ADHD) also met the criteria for bipolar disorder.

The documentary showed that the rapid increase in bipolar diagnoses was accompanied by an increase in prescriptions of antipsychotic drugs and mood stabilizers, used to quell disruptive behaviors and mood swings in children.

In the years following 2008, when the documentary premiered, concerns grew that bipolar was not the appropriate diagnosis for all the behavioral patterns practitioners saw. Researchers tried to address this problem in 2013, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide doctors use to diagnose mental illnesses. They added a new diagnostic category for children who exhibit strong emotional outbursts and frequent irritability called disruptive mood dysregulation disorder.

The new diagnosis appeared in the depression chapter of the textbook, which may mean that antidepressants often become the first line of treatment, said Dr. Eric Youngstrom, a clinical psychologist who co-chairs the Childhood Diagnosis Working Group on Depression. International Society for Bipolar Disorders. But Youngstrom also said there are numerous studies and analyzes showing that antidepressants aren’t very effective at treating disruptive behavior problems.

So there’s this group of kids that the book is trying to decide, do we look at it as a behavior problem or do we look at it as a depressive problem? he said.

The World Health Organization went with the former, choosing to add a new subdiagnosis to an existing behavioral disorder, instead of adding disruptive mood dysregulation disorder to its diagnostic manual.

From The medicated child on air, studies have shown a decline in antipsychotics prescribed to children. Two recent studies found that antipsychotic prescriptions decreased from the late 2000s to the late 2010s in both privately insured and Medicaid-insured children.

Dr Stephen Crystal and Dr Greta Bushnell, two of the study’s authors, said the decline in antipsychotic prescriptions for children was driven by new safety guidelines, as well as stricter requirements for prescribing such drugs for children. children with Medicaid. Several states require providers to receive approval from the state Medicaid agency before prescribing antipsychotics to children, another hurdle related to declining prescribing. Bushnell and Crystal concluded that this also had spillover effects on privately insured children.

The researchers also observed a decline in the number of children taking antipsychotics specifically for the treatment of bipolar in both the privately insured and Medicaid groups.

That tendency to attribute mood problems, mood swings, challenging behaviors [to] Bipolarity has been somewhat debunked, said Crystal, director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.

But medications can still be an effective treatment for some children. For children dealing with mood dysregulation disorders, including bipolar, caregivers’ and families’ decisions about whether to take medications must factor in the risk of not treating, said Dr. Janet Wozniak , director of the pediatric bipolar disorder research and clinical program at Massachusetts General. Hospital, in a hospital presentation in January 2020. Delaying treatment, she said, can worsen outcomes in adulthood.

It is terrifying to write these prescriptions; it is terrifying to receive these prescriptions. But what’s more terrifying [is] not treating, he said. Because there are suicide attempts, there is poor judgment, there is reckless behavior, there are criminal arrests, abuse and addiction.

The growing need for therapy outstrips resources

Jacob Solomon was diagnosed with bipolar disorder, ADHD and autism and later Asberger syndrome when he was a child. At one point, he was taking eight different drugs at the same time.

Solomon was 16 when he arrived The medicated child. At 32, she still identifies with each of these disorders and, after years of trial and error and constant healing, she has said she feels like she’s found what works for him.

I really think that being where I am now, having been through all of this, is what matters, she said in a recent interview with FRONTLINE. I passed it.

Solomon works for United Airlines as a flight training planner and DJ in Denver. He produces and records his own music and has just finished his first album. Now he takes four drugs that he thinks help, but he has found maximum clarity by going to the gym every day. Solomon is not in therapy at the moment, he is currently using ChatGPT as a replacement counselor but has said he wants to get back to therapy soon.

Clinical guidelines recommend that children be counseled with or before using psychiatric drugs. However, Bushnell and Crystals’ study of privately insured children from 2007 to 2017 found that only half of the children prescribed antipsychotics had visited a psychiatrist or received treatment.

Dr. Laura Chavez, a researcher at Nationwide Childrens Hospital in Ohio who has studied the use of antipsychotics and anxiety medications in children, observed a similar dynamic in a 2023 study she co-authored: While diagnoses of anxiety increased from 2006 to 2018, outpatient visits for therapy decreased.

And in recent years, the number of children and adolescents reporting symptoms of anxiety and depression has grown. Diagnoses of ADHD are also on the rise.

Chavez said that despite growing mental health needs, resource shortages have contributed to a decline in therapy visits for children and adolescents.

Primary health care providers are indeed facing an onslaught of patients who really need help but have perhaps the least resources at their disposal to provide mental health, Chavez told FRONTLINE. Not a problem, we will be able to prescribe our way out.

Kennedy and Solomon grew up with drugs as their primary form of treatment, and both said they’ve now found ways to manage their mental health that aren’t entirely dependent on them. They live alone, something they think others didn’t think was possible when they were children. Kennedy is planning on pursuing a career working with children, working towards a degree in early childhood education.

Looking back on her childhood, Kennedy said: Even though I didn’t have the vocabulary to articulate many things, which made things much more difficult, I feel like paying more attention to the child, and asking the child, and therapy would be big help.

---