Here’s a bit of news that may come as a surprise: the National Institute of Mental Health, analyzing survey data from more than 10,000 13- to 18-year-olds, has found that — contrary to popular belief — American teens are not being overmedicated for mental health disorders.
They’re not entering psychiatrists’ offices with problems no greater than sub-Ivy League-level grades and walking out with enough scripts to fill a private pharmacy. And they’re not being “drugged” to deal with healthy sadness, normal levels of frustration, or typical teenaged anger.
The researchers, led by Kathleen Merikangas, senior investigator and chief of the Genetic Epidemiology Branch in the Intramural Research Program at the National Institute of Mental Health, reviewed data that focused specifically on teen medication use and mental health history that was gathered in 2004 by the National Comorbidity Study: Adolescent Supplement, a huge, nationally representative, face-to-face survey.
Eager to investigate anecdotal and media reports of American teens taking meds for trivial, even trumped-up causes, they compared rates of psychotropic medication use to the prevalence of mental illness in their sample, using criteria from the diagnostic “bible,” the DSM-IV, to assess symptoms and their severity. They then looked specifically for medication overuse (i.e., the prescribing of meds to teens who don’t actually have mental disorders) and medication misuse (the prescribing of meds to treat disorders for which they’re not indicated).
According to the results, some overmedication did exist — just under 2.5% of teens without a diagnosable disorder in the past year reported having received meds nonetheless — but the authors cautioned that these teens either had neurodevelopmental disorders, lingering signs of previously diagnosed mental disorders, or “subthreshold conditions” that didn’t rise to DSM-IV standards but nonetheless caused them “psychological distress or impairment.” Yet the general picture suggested much more under-medication than excessive use. An earlier analysis of the same survey data, which drew together in-depth diagnostic interviews of teens with parent interviews to ascertain what sorts of services they’d accessed for their kids’ care, had shown that 20% of the young people surveyed had, at some point in their lives, suffered from a mental health disorder severe enough to affect their ability to function. The new data, which looked specifically at how that sub-population of kids had fared in the 12 months prior to being surveyed, found that only 14.2% of the teens with a diagnosable disorder had received medication for it.
“There was no compelling evidence for either misuse or overuse of psychotropic medications,” the researchers concluded, adding that the lack of medication use in treating conditions that have been proven to respond well to them—stimulants for A.D.H.D. and S.S.R.I.s for depression and anxiety in particular—suggested that kids weren’t getting the best standards of care.
These are important findings because the belief that American teens — and children in general — are being grossly overdiagnosed and overmedicated by pushy, perfection-seeking parents, lazy educators and complicit doctors is one of the major tropes of our time. That “they’re all” on something — mostly medication for easily-faked ADHD, as is most frequently charged — is a throw-away line at dinner parties and in casual conversation. What this talk does is trivialize disorders that are real — and cause their sufferers significant suffering and pain. At the very least, mental disorders make the tasks of everyday life — everything from getting homework done to having friends — much harder: more exhausting, more frustrating, more stressful. At worst, they can lead to horrible social isolation and suicide.
If everyone “has something,” as it’s often put, then no one does. If “they’re all on drugs,” then, clearly, none should be. The danger of exaggerating the use of psychotropic medications by children and teens is that it denies both the seriousness and the reality of the conditions that drive parents, reluctantly, to seek help for their kids in the first place. The exaggeration has also fed a sense, among many parents, that to seek specialized mental health care is to risk falling victim to the machinations of a pharmaco-industrial-complex that will suck their children in and “drug” them for life. This fear has left many children who really need help with no hope of getting care at all.
Let’s hope that this new study — dry, mind-numbingly number-crunching, as it is — will somehow manage to make headlines. And that it will maybe add some much-needed nuance to the long-overreported story of America’s overmedicated kids.
By Judith Warner
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