Should I Medicate My Child?

by Lawrence H. Diller
Basic Books, 2002
Review by Christian Perring, Ph.D. on May 14th 2002

Lawrence Diller's new book Should I Medicate My Child? presents straightforward advice for parents about their options when their children face emotional and behavioral problems and diagnoses such as ADHD, depression, oppositional defiant disorder, conduct disorder, and bipolar mood disorder. It is relatively short, at 243 pages, and it is full of discussions of real life cases based on Diller's clinical experience. His main message is that there are many approaches to treating children, and medication can be a reasonable choice, it is certainly not the only one available. Many psychiatric medications used on children have not been comprehensively tested for their safety or efficacy when used with children, and of those that have been tested, a good number have been shown to be of little help. It is often safer and more effective to deal with mental health problems in children by changing the parenting style or using very specific techniques of rewards, warnings, and punishments.

Diller's view is that medication should not necessarily be the first resort in treating children, and he is very concerned by the trends of escalating prescriptions of stimulants, antidepressants, anti-anxiety pills, mood stabilizers, and antipsychotics for children and adolescents. Roughly 5 million children in the US are currently on psychiatric medication; 4 million of those are taking stimulants such as Ritalin, and many are taking two or more drugs. According to the DEA, production of Ritalin increased by over 700% between 1990 and 1998. About 15,000 two-year-olds were prescribed Ritalin in 1995.

A 1994 study showed that roughly 1-2% of children and adolescents are taking antidepressants, but figure rises to about 4% for 15-19 year olds. Only about 13% of children and adolescents diagnosed with depression received a prescription for antidepressants. Another 32% received psychotherapy alone, 36% received both, and 20% received neither. In 1997-8, about 0.4% children under 5 received medication for emotional or behavioral problems. Estimates for the rate of major depressive disorder (MDD) in children vary, but one recent article in a respected journal gave figures of 1% of preschoolers, 2% of school-aged children, and 5-8% of adolescents. The number of children with mood and anxiety disorders seems to be increasing with each generation, and the age of onset seems to be decreasing.

Most psychiatric prescriptions are written not by child psychiatrists but by general practitioners and pediatricians. One study showed that just 8% of its sample of non-specialist physicians felt that they had adequate training to treat childhood depression. HMOs and health insurance pressure doctors to see more patients, spending less time with each child, and it is not surprising that more parents are leaving doctors' offices with a prescription rather than a recommendation for family therapy and many follow-up visits.

Diller discussed many of these trends in his earlier book Running on Ritalin; that book focused particularly on Attention Deficit Hyperactivity Disorder, and was more scholarly, being considerably longer, with footnotes, and discussing in depth our society, psychological theories, and our treatment of children. Should I Medicate My Child? is a simpler book aimed at a wider readership. Although it discusses a wider range of psychiatric conditions, it is more focused on the treatment options available for children and their families. It guides parents who are unsure how to proceed when dealing with their children's emotional problems, explaining what to look when searching for a clinician, and it emphasizes the alternatives to medication that are safe and effective.

All of Diller's ideas seem sensible and helpful, although some of his claims may be controversial. He says that spanking can be part of a reasonable parental reaction when dealing with a troublesome child, although it should not be used excessively. He argues that it can less painful than physically restraining a struggling child, and it can be effective in communicating disapproval of a child's behavior. He also makes clear that parents should not use physical punishment when children are strong enough to fight back, because this can become dangerous.

Should I Medicate My Child? is written clearly and is structured logically. While it may not answer all parents' questions, it should be very helpful for the many who worry about medicating their children and want to know what the best approach is to dealing with their children's problems. Recommended.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island. He is editor of Metapsychology Online Review. His main research is on philosophical issues in psychiatry. He is especially interested in exploring how philosophers can play a greater role in public life, and he is keen to help foster communication between philosophers, mental health professionals, and the general public.

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