Red pill or blue pill?

There was an article this morning in the newspaper (online) regarding overmedication and over diagnosis of young children, even infants. The profiled child had received multiple diagnoses before the age of 3 including autism, bipolar disorder, hyperactivity, insomnia, and oppositional defiant disorder. As a result, he had been prescribed an increasingly greater number and potency of medications originally developed for adults. Finally, after years of bouncing around from one medical practice to another, he was weaned off of these meds and given a much simpler diagnosis: attention deficit disorder. Or in other words, he’s a kid. An active little boy, to be fair, but a perfectly healthy little boy.

There are many aspects of this case and the other cases like his that are frustrating and worrying. The over diagnosis of our children, and our infants for that matter, causes an inaccurate estimate of the burden of disease in our society. Do we really have an increased population of children with attention deficit or are we more quick to label a child who will grow out of this phase of hyperactivity and mellow with age? How do we distinguish between an active toddler and one with a real, treatable disorder? Many of these drug therapies were originally created for adults. What are the long term effects on the developing body and mind of a child? Several drugs prescribed to children have side-effects. One side effect of some of these drugs is insomnia, so a sleep aid is prescribed. If a side-effect of that sleep aid happens to be constipation, then do we also prescribe a laxative? Is this a pharmaceutical merry-go-round without an exit? Is it better to develop novel behavioral “therapies” for children or to medicate them to the point that they are blank, vacant automatons, albeit more easily handled?

The questions are far more troubling than the responses. As parents, it’s important to ask the questions. Ask them frequently, ask them more than once, keep asking until the answer makes sense and is consistent. Don’t be afraid to ask for a second opinion. Doctors are also human, some are parents, some are more prone to diagnosis and prescribing drug therapies. But in the end, none of them are the parents of your child and thus have different priorities than you regarding the health and welfare of your child. And regardless of all the schooling and training, none of them are an expert on your child like you are – you know best what is “normal” behavior from your child. What is the regular energy level and appetite for your child or affection level. Doctors are here to help, to be a source of information and a safeguard against real health threats for your child. But they are not perfect. If something feels wrong, it might very well be – or it might be the best therapy and you just need more information. Therefore, ask, ask, and ask again until it makes sense to you.

Are there children who have real medical disorders? Of course. Do they need the attention and care of doctors? No question. But is there also a spectrum of childhood behaviors and activity that encompasses hyperactivity and diminished attention span? I believe there is indeed. Our 26 month old toddler is incredibly active. She has a difficult time sitting still for a meal let alone all day long. Her preferred activities are to run around the median of the house, dance, play ring-around-the-rosy, enjoy the playground with swings and slides, and practice throwing and catching objects. She also likes to read and draw and impress shapes into playdo, and she loves to climb her parents like a monkey gym. Does this mean she has attention deficit disorder? I doubt it. Her doctor thinks she’s a perfectly healthy little toddler as well.  She may be very active, she may hate to sit still or lie still (e.g. diaper changes) when she is forced to stay still, but I attribute that to a battle of our wills and her increasingly stronger desire for independence and control. I’m also fairly reassured that at this rate, the risk of childhood obesity and its related conditions are fairly low for her.

I also feel grateful every single day for her health, for her love, for her very existence. I know without question that we are one of the lucky ones and we are blessed to have her in our lives. Would I move heaven and earth to find a cure if anything ever happened to her? Of course, without doubt, no question. But I would question every step of the way, I would find second and third opinions, I would assemble a team of doctors and experts who believe in her and her holistic health, almost as much as her father and I would. And no matter what, I would love her for who she is, the totality of her, screaming tantrums, opinionated assertions, and refusals of kisses and all. Bring on the terrible two’s – I’m just grateful I have a munchkin I can hold and kiss, even if it is against her will sometimes when she would rather be at play.