Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 211-212 (doi:10.1542/peds.2008-0879)

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LETTER TO THE EDITOR

Are We Overmedicating Our Children?

John W. Harrington, MD
Division of General Pediatrics
Eastern Virginia Medical School/Children's Hospital of The King's Daughters
Norfolk, VA 23507

To the Editor.—

I was dismayed, yet not surprised, after reading the report by Mandell et al¹ concerning psychotropic medication use among children with autism spectrum disorders. Having a child with classic autism who is now 12 years old and treating >150 families in 2 different states (New York and Virginia) who have children with autism, I have personally witnessed the increased use of psychotropic medications and their adverse effects. However, the evidence-based data for this increase are sparsely supported in the literature.^2,3 I understand that some children with autism may inevitably require medications, yet having toddlers and small children placed on antidepressants, neuroleptics, anxiolytics, and mood stabilizers when their neurodevelopmental architecture is quite vulnerable should make general pediatric physicians pause and wonder what they are treating. Theoretically, we can manipulate the serotonin and dopamine receptors with a pill and perhaps modify outburst and anxious behaviors, but I fear that we have relegated intensive persistent behavioral strategies to the background for parents who may not have the time or the skills to manage these difficult children.

In their recent review of management and treatment of autism, Myers, Johnson, and the American Academy of Pediatrics⁴ appropriately state the exhaustive approach one should take before outlining a course of psychotropic medication and provide a comprehensive table that should be memorized by anyone taking care of these children and their families. I have used many of these techniques and have found that many times I can alleviate identified problems and obviate the use of medication in my population. However, this labor-intensive, modeling, and cheerleading exercise will take several 1-hour visits with motivated parents. Compare this to a subspecialty visit in which the physician may see the child once and start 1 or 2 medications after a 30-minute visit and provide medications that may initially provide relief to stressed parents who are looking for any type of control. What gets lost is the need to also train parents on behavioral management techniques so that, as the child gets older, the ability to control them will not require ever-increasing doses of these medications or the need for multiple medications.

Are we unwittingly providing medical restraints for children because we have not provided parents with the tools to care for their child with autism? Anecdotally and in practice, I would say yes. Searching for triggers that cause outbursts and difficult behaviors and teaching parents strategies for combating them are the frontiers that need to be breached, not the development of a newer medication with the least amount of adverse effects that can provide a quick fix.

REFERENCES

1. Mandell DS, Morales KH, Marcus SC, Stahmer AC, Doshi J, Polsky DE. Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics.2008; 121 (3). Available at: www.pediatrics.org/cgi/content/full/121/3/e441
2. Shea S, Turgay A, Carroll A, et al. Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics.2004; 114 (5). Available at: www.pediatrics.org/cgi/content/full/114/5/e634
3. Kolevzon A, Mathewson KA, Hollander E. Selective serotonin reuptake inhibitors in autism: a review of efficacy and tolerability. J Clin Psychiatry.2006; 67 (3):407 –414[Web of Science][Medline]
4. Myers SM, Johnson CP; American Academy of Pediatrics, Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics.2007; 120 (5):1162 –1182[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Harrington, J. W. Search for Related Content PubMed PubMed Citation Articles by Harrington, J. W. Related Collections Therapeutics & Toxicology Social Bookmarking                         What's this?