September 18, 2013
Posted in: Teenagers
I’m a psychologist, and psychologists don’t prescribe medication. Despite the fact that I don’t prescribe, one of the most frequent questions I’m asked is, “Aren’t there too many kids on medication?” The short answer to this question is “probably not,” as research would show that at least one-third and up to one-half of children with serious psychological problems go untreated. That’s a lot of kids who need help—either through some sort of therapy, or (for some) medication. But for many of us, those numbers just don’t ring true—even though they are. This could possibly be because some kids are getting medication even though they don’t necessarily meet criteria for a serious psychological disorder. There isn’t data that shows this is necessarily true, but sometimes I’m confronted with situations that would make people think otherwise.
A couple of years ago, my son (who was then a junior in a top-ranked suburban high school) came home and told me that his history teacher mentioned to the class that over 30% of kids in the school were on an anti-anxiety or anti-depression medication (that was in addition to ADHD medication). This data was generated from the information forms that parents fill out at the beginning of the school year that ask parents for information such as who to contact in an emergency, and the types of medications their child is taking. This rate of psychiatric medication seemed high to me; after all, we have a pretty good idea about the prevalence rates of serious emotional problems in kids. Somewhere between 14% to 20% of children will struggle with a serious emotional problem at some point in their development, and up to 25% of children will struggle with some type of emotional or learning problem. Given these statistics, a rate of 30% for psychiatric medications in my local high school is far above the national average. It would imply that some of these children may be receiving medication they do not need.
I should state clearly that MANY of these adolescents likely benefit from medication, but why would the rate of medication in an academic environment that is arguably better-than-average be so high?
Let’s first look at the history teacher who shared this information with the students. This teacher is excellent. In fact, he’s better than any history teacher I personally encountered in college. As an excellent teacher, he demands a high level of work, which can include reading original journal articles and writing papers frequently. In fact, the course requirements include two lengthy research papers during the semester, and one to two shorter reaction papers per week. That’s a lot of work for a 16-year-old.
The typical 16-year-old in this high school has to juggle at least 5 other classes that may be even more challenging—subjects such as AP Chemistry or Physics, or an English class that requires reading a novel every two weeks. These kids are in class from 7:30am until 2:30pm every day. After school, they participate in extracurricular activities that continue past dinnertime. Sports practices that once were an hour or two after school now last two or more hours, and then there are sometimes consultations with the sports trainer, and possibly additional workouts. It’s also a requirement of graduation for students to fulfill a certain number of hours of volunteer work. Add all of these hours up, and you have one stressed kid–most adults could not handle this schedule! There is little time for sleep, and even less time for fun. Is it possible some of these students are taking medications because they are stressed, situationally depressed, or overwhelmed (perhaps because they are being asked to perform in ways that most adults cannot)? I can’t truly answer that question without interviewing each one of those students, but it’s quite possible some of them are.
In contrast to these students, there are many adolescents who are in academic environments that don’t meet their needs at best, and that put them in unsafe situations at worst. The rates of psychiatric medications in these students are below what we’d expect based on prevalence rates. In other words, there are students in these schools who probably would benefit from psychiatric medications but who go untreated.
Thus, the answer to the question, “Are too many kids on medication?” depends on where you look. If you’re standing in a suburban school where 30% to 40% of kids are taking psychiatric medication, you may be justified in answering “yes” to this question. However, if you’re standing in an inner-city or a rural school where there is one psychiatrist in a 400 square mile area, and many children in need are not getting the help they deserve, you’d be correct in saying “no.” Overall, the children who actually require medication but don’t receive it outnumber those who may be receiving medication but not really “need” it. In either case, something needs to change.