Youth prescribed psychotropic drugs much more often for behavior modification

Recently, in an item titled "Hypothesizing reasons for continued crime declines," Grits mentioned the theory that new and improved pharmacology is a contributing factor to reduced crime, particularly juvenile crime. So I was interested to see data describing the growth in behavior modification drugs given to youth, particularly for attention deficit disorder. According to Reuters:

From 2002 to 2010, the use of ADHD drugs grew by 46 percent -- or some 800,000 prescriptions a year. The top drug dispensed to adolescents was the stimulant methylphenidate, also known as Ritalin, with more than four million prescriptions filled in 2010.

"What the article is suggesting is that the number of children that we are treating for attention deficit disorder has gone up," said Dr. Scott Benson, a child and adolescent psychiatrist and a spokesperson for the American Psychiatric Association.

"For the most part I think the overall increase reflects a reduction in the stigma," he told Reuters Health. "It used to be, ‘You're a bad parent if you can't get your child to behave, and you're a doubly bad parent if you put them on medicine.'"

Dr. Lawrence Diller, a behavioral pediatrician who has written extensively about ADHD, was more critical of the rise in stimulant prescriptions, noting that the U.S. is far ahead of other countries in its use of the drugs.

"You have to look at how our society handles school children's problems. It's clear that we rely much, much more on a pharmacological answer than other societies do," Diller said. "The medicine is overprescribed primarily, but under-prescribed for certain inner-city groups of children."

See the abstract from the paper described. Overall, prescriptions for youth have recently declined, but mostly that's because of a reduction in antibiotics given out, a reaction to their massive over-prescription in years past. At an instinctive level, Grits is not a fan of the idea of medicating kids to instill good behavior as opposed to, say, teaching them. I understand the "stigma" attached to drugging one's kids to rein in bad behavior and part of me considers it justified (certainly IMO it should be a last resort). But Grits remains open to the notion that such medications have reduced misbehavior and even criminality among youth, though I've never seen someone try to quantify the scope of that effect. Whether that's a good or bad thing overall depends on whether the drugs also reduced creativity, stifled emotional development, whether they prevent acquisition of tools for self-control sans medication, and a host of other aspects that can't be measured by student behavior scores or crime-rate data.

I also wonder about the suggestion that psychotropic drugs are "under-prescribed for certain inner-city groups of children" (read: minority youth). Another article from the journal Pediatrics published this month declared that "Maladaptive aggression in youth is increasingly treated with psychotropic medications, particularly second-generation antipsychotic agents. Multiple treatment modalities are available, but guidance for clinicians’ assessment and treatment strategies has been inadequately developed." But if assessment and treatment strategies have been "inadequately developed," I'm unclear how they can make the normative assessment that psychotropic drugs are "under-prescribed for certain inner-city groups of children"?

According to another article from Pediatrics, "In children and adolescents the Second Generation Antipsychotics (SGAs) represent the class of psychotropic drugs whose use has grown more significantly in recent years: they are primarily used for treatment of patients with disruptive behavior disorders, mood disorders and pervasive developmental disorders or mental retardation." Notably, though, the side effects of using antipsychotics for behavior modification in non-psychotic youth are only beginning to be understood. According to this article, "In randomized studies, adverse effects were usually relatively minor, easily predictable and manageable, whereas long-term open-label studies have indicated that some adverse event, such as the metabolic effects, may be severe and potentially life threatening on the long-term."

The relation between pharmacology and crime reduction is an issue Grits would like to delve into deeper. The medical landscape has changed dramatically in the last decade regarding psychotropic drugs for youth, but the public policy implications remain poorly understood. We know the pharmaceutical companies benefit from these trends, I just hope it's also true that the kids do.