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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.
© 2002 Christian Perring. First Serial Rights.
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. |
