In the US, an increasing number of parents are turning to psychoactive medication to help them cope with the challenging behaviour of their children. So is this an understandable path to take, or a worrying shortcut, asks Louis Theroux.
On a kitchen countertop in their suburban Pittsburgh home the Kelley family keep a small collection of pill bottles. They jokingly refer to is as "Hugh's personal pharmacy".
Hugh, aged 10, appears basically normal - a dark-haired kid who goes to a mainstream school and speaks and interacts well, albeit sometimes in a slightly aloof and off-hand way. Yet he has been diagnosed with a range of mental disorders and put on a battery of medications.
'It's very troubling'
He takes Adderall for his attention deficit hyperactivity disorder. Tenex for impulsiveness. And for his bipolar disorder he is on a heavy dose of a powerful anti-psychotic called Seroquel - in an "off-label" prescription, meaning it hasn't been tested on children.
"It's very troubling," Hugh's mother Barbro told me when I asked about his reliance on the medication. "The problem with it is, if you continue not to medicate with something for bipolar disorder in a child, the highs and the lows, the cycles get worse and worse."
I was there for a documentary about the growing number of children who depend on psychoactive drugs to regulate their behaviour, basing myself at one of America's top hospitals for children's psychiatric issues, Pittsburgh's Western Psychiatric Institute.
Barbro and her husband Bob had been kind enough to put me up for part of my stay, as a way of getting to know a family with a medicated child and experiencing some of his behaviour.
The entire Kelley family - even the dog - were on psychoactive medication, except for the young daughter, Maeve
The family, judged by British standards, seemed surprisingly open to the concept of psychoactive medication. Hugh's mother was on an anti-depressant, Prozac. Bob took something called Neurontin for a bipolar condition he says he "may or may not have".
Even the dog was being fed Clomipramine, an anti-anxiety pill.
But Barbro said they had resisted medicating Hugh. She said they came to the decision to put Hugh on drugs reluctantly and with reservations, and only because the alternative - allowing his emotions and behaviour to continue untreated - was too awful to contemplate. Hugh's younger sister, Maeve, was on no medication at all.
In many ways, the Kelleys embody one of the biggest and most controversial debates embroiling America right now - the question of children and whether they are being overmedicated.
Children who a few decades ago would have been written off as naughty, troubled, or delinquent are now being diagnosed instead: "ODD" for oppositional defiant disorder, "CD" for conduct disorder, "SAD" for social anxiety disorder, "GAD" for general anxiety disorder, and so on.
Critics of the phenomenon see it as rampant overmedication. Some call it "cosmetic psychopharmacology" or "steroids for the soul". They say kids are being medicated in lieu of proper parenting - or that the diagnoses are being sought by "pushy parents" looking to give their kids a competitive edge - since some of the drugs have "performance enhancing" qualities.
The Kelleys view their "personal pharmacy" of drugs as a "godsend"
They also worry about the side effects of the drugs - and the long-term consequences of taking psychotropic medication. Unlike the stimulants prescribed for ADHD (Ritalin and so on), which have been around for more than 50 years and which studies suggest are basically safe, little is known about anti-psychotics and their effects on children's still-growing brains.
But while it is easy to make fun of many of the diagnoses - and understandable that we should be wary of the medications - it is clear that for many of these families the medications have been a lifeline.
Hugh's parents said they cannot contemplate life without the medication. His behaviour was just too challenging.
He didn't get along with his peers. He was slow to pick up social skills - wasn't good at maintaining eye contact, for example. He seemed to think he knew better than anyone else on most issues. He was sarcastic and aloof in a way that belied his age. He often seemed angry.
He also suffered from mood swings, going from giddy and silly to gloomy and self-hating. He had bouts of not needing sleep and becoming grandiose - having an inflated sense of himself and his place in the world.
On one occasion, after being told off by his mother, aged eight or so, Hugh reacted by threatening to throw himself in front of a car on a road near their house. Shortly after this incident, he was diagnosed with bipolar disorder.
During my stay with the Kelleys, it was clear that Hugh wasn't your average 10-year-old. He could be moody and superior. During one argument with his sister he made a (not-too-serious) threat about hurting her. He then made the memorable pronouncement: "If the world is my nemesis, then I'm their nemesis."
When I attempted to interview him he was occasionally a little abrasive. He had a habit of wandering off without explanation during my questions.
But it was hard to know to know how much of his anger was "pathological" and symptomatic of a real condition - and how much was simply a moody 10-year-old acting up. And it was also true that he was highly intelligent, creative and capable of great charm. By the end of my stay, I'd grown to like him a lot.
In the end, there are no easy answers to the medication debate. I left the Kelleys more open to the idea of "drugging kids" than I'd been when I arrived. I could see that, for all the unknowns involved and the lack of long-term data, families like the Kelleys viewed the medication as a godsend.
But I also realised that doctors and families are still operating to a great extent in the dark.
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