Saying ‘yes’ to drugs

Very troubled children are being given very powerful antipsychotic rugs, often prescribed “off label,” with no evidence of effectiveness, writes Judith Warner in her New York Times blog.

. . . the “atypical” antipsychotic Risperdal, a tranquilizing whopper of a drug with serious, sometimes deadly side effects, is now being widely prescribed to children with attention deficit hyperactivity disorder.

This despite the fact that Risperdal, which is used in children mostly to treat bipolar disorder, isn’t approved for A.D.H.D., and apparently doesn’t work for treating it at all.


I think that what’s happening is that children with big problems are being given big, bad drugs because no one really knows what to do with them. . . .  (More children are) “chronically irritable, extremely aggressive, prone to explosive outbursts and out-of-control rages.”

Diagnoses of bipolar disorders have spiked. But is that the problem? Some say it’s “extreme A.D.H.D.” or Oppositional Defiant Disorder or “severe mood dysregulation” or . . .  Well, some blame very bad parenting. There’s no consensus on what’s wrong and no data on what kind of medication helps.

About Joanne


  1. Thunderbottom says:

    When I was in school (eight years parochial, four years in a public high school), one never heard of ADD and ADHD. While there were “problem kids” in my classes, to my memory, it wasn’t the pandemic that I’m reading and hearing about now. I think that a big part of the problem is that many parents have become more and more disengaged from the raising of their children, deferring to the “experts”. When a kid starts acting up, the bewildered parents take the kid to some “expert” who diagnoses the child as having ADD or ADHD (thereby absolving the parent of any responsibility) and prescribes some powerful psychotropic to “lower the child’s anxiety levels” and “even out his mood”. I also think that many parents and teachers can’t or won’t handle the not-infrequent rambunctious and contrary behavior that children, especially boys, display. It disturbs them. Not infrequently, many parents and teachers are taking prescribed mood-altering drugs (like Xanax) themselves. Hey, they think – it works for me; why won’t it work for my child?

  2. TB:

    I don’t know when you were in school, but it is possible that those eight years in parochial school coincided with my early years in public school. Every year we got a few kids who moved over from the parochial schools–where they were not responding well to the discipline there. I was in “gifted” classes, and a few came our way as well. With high school a big bunch who didn’t get into the parochial high schools came our way. The public system had a variety of ways to respond to kids who had problems. There were the lower track classes (shop, business math, typing, etc). There were the “sped” classes (I still hate that term–my parents fought hard to keep my brother, with ADD, out of special education) and other special schools.

    There are more kids being treated for behavioral disorders today–many of them on drugs. But it is a complex set of circumstances. One reason for prescribing “off label,” is that so many drugs have never been tested on children. We don’t have a solid research base on which to make decisions. DSM-IV doesn’t have a pediatric diagnosis for bipolar disorder, although there have been researchers working to isolate symptoms. There is some indication that adult bipolars experienced symptoms for many years before diagnosis–going back to childhood, lending support to the need for a pediatric diagnosis. For the time being, kids have to be diagnosed as bipolar NOS (not otherwise specified). It is incredibly difficult as a parent to experience the hell that your child is experiencing day after day, and to confront a bank of not terribly well researched drugs to try to alleviate symptoms. It feels like one big guessing game. But these are the realities on the parenting and medical/counseling side of the equation.

    On the school side, there is a strong belief that “these kids” don’t belong where ever they are. They should be fixed or sent somewhere else. The autistic kindergarten kid whose teacher had him voted out of the class is really just the tip of the iceberg of non-understanding. I could tell you stories…

    I would suggest that the befuddlement that some parents face in the arena of discipline (I love Nanny 911), is not fundamentally different than that faced by some teachers. In a generation or so we have undergone a sea change in our societal acceptance of corporal punishment of children. There are still parents who are firm believers (although they may be very careful about who sees them) and I would submit that some of these are teachers. Other parents, and teachers, are laissez-faire and hope it will all work out (with enough love). This ambiguity can provoke some extreme testing from kids who just don’t know what to expect. Yet, I haven’t seen too many kids who didn’t respond to clearly articulated and demonstrated systems of behavioral expectation. Most behavior is learned–but we don’t know a whole lot about how to teach it.

    But toss into this ambiguity some kids who really have bio-chemical disorders, and we can really compound the difficulties. We have the broad spectrum from take-no-prisoners to to-each-his-own (with the weight in recent years on the take-no-prisoners side), and very little knowledge of how to deal with our adult disagreements on these issues. Many teachers balk at the suggestion that they add a discipline plan for a disordered kid to the things that they already do. To be fair, there generally should be more support from special education personnel for kids who are included in classsrooms. This isn’t likely to happen as long as we remain deeply wedded to the “send them somewhere else” philosophy–because it keeps all the special ed personnel busy teaching classes in “resource rooms.” They get support from parents who see kids with problems as being problems–and want their kids not to have to interact with the problem kids. But the sad result is that kids who need help (and stability) get bounced around (and suspended and expelled) an awful lot. Is it any wonder that we keep trying more and more powerful, yet untested, drugs?

  3. I’m ready to put most of the blame in the one case closest to home on bad parenting. My 11-year-old niece was put on medication for “crying jags”. IMHO, that was a nonsensical thing to do. Her parents were separated and behaving incredibly badly back then. She had plenty of rational reasons to cry! They certainly shouldn’t have put her on mood-altering drugs just as her body was getting ready to enter puberty. Good grief!

  4. Based on my reading, these mood-altering/anti-depression drugs alter brain chemistry by destroying neurons. Over time, extensive use of these drugs reduces IQ. Even worse, the long-term effects of these drugs, on adults or children, is competely unknown.

    I have a bad feeling that in 30 years there’s going to be an epidemic of brian tumors from people who spent decades taking these drugs on a daily basis.

  5. Margo,

    To invert Einstein, “Make it as complicated as necessary – but no more”.

  6. … because no one really knows what to do with them.

    I beg to differ. Somebodies do know what to do with them. For examples, see the work of Bill Pelham and his colleagues at the Center for Children and Families of the University at Buffalo.

  7. Sir Jecht:

    Can you share the source of some of your reading? I am particularly interested in the cognitive effects that you suggest.

  8. Every child responds to the medications differently. Some work great for some kids, but other kids don’t tolerate them. Everytime we try a new medicine to try to help the child that is clearly suffering in school, it is an experiment in which medicine and dosage. You have to observe the kid and see if the results are an improvement. My kids have become cranky, prone to 2 hour long temper tantrums, had non-stop tics for 24 hours until the drug wore off, suicidal – all from standard drugs routinely prescribed for ADHD and anxiety. After a few years of trying things out, we seem to have found some very low doses of medications that improve their life. I have taken them off of everything for periods of time – only to have anxiety cripple their work output and make them generally irritable and frustrated. ALso getting my kids into classrooms with well trained teachers in behavior and LD teaching methodolgies helped immensely, but it isn’t the only piece of the puzzle.

  9. Lightly Seasoned says:

    I think it is obvious that one cannot make blanket statements of any sort about this issue. I’ve certainly seen kids overmedicated for ADHD and students who obviously needed something to survive high school. I get a large percentage of these kids in my classes, and they are tough, tough, tough sometimes. And sometimes they’re a pure delight.

    I do know that there are always kids who do not belong in a large comprehensive high school because they can’t handle the intense social interaction. I will make as many accomodations as are called for and they have an absolute right to be here, but why are we exacerbating mental illness by forcing them into an environment that is not a good fit? The lack of personal space gets to ME sometimes, and I at least have a quiet half hour at lunch and don’t need to try to shove myself through the halls during passing period. Kids get absolutely zero time to be alone and decompress during the typical school day. How much medication could be dumped if they simply went to a setting more suited to them? One of my students this year wanted out so bad he tried to set the building on fire — during the school day.

  10. I think that a significant chunk of what used to be considered normal behavior (especially the active-boy type) has been redefined as abnormal/pathological. Certainly my elementary-school teachers (3 of my first 4 did not have college degrees, but they were very good teachers) coped much better than I have observed over much of the last 25 years.

    Also, “back in the old days”, self-control was taught to be a positive virtue. It has been since the 60s that expressing all of your feelings (whatever the effect that might have on anyone else) has been tolerated in a school situation, let alone be seen as a virtue. Add to that the constant-stimulus situation of TV/video games and parents who aren’t able/willing to socialize their kids appropriately and there are far more kids who are unable/unwilling to control themselves and far less capable of paying attention and staying on task in a classroom situation. These are skills that need to be taught from infancy. Even chilren under the age of one can learn to wait a few minutes in their high chair before meals, toddlers can learn to wait their turn etc.

  11. Google “Dr. Joseph Biederman.” There’s an article in the New York Times just this week about the doctor’s effect on drugging children (

    “Dr. Biederman’s work helped to fuel a fortyfold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder and a rapid rise in the use of powerful, risky and expensive antipsychotic medicines in children.”
    “In June, a Congressional investigation revealed that Dr. Biederman had failed to report to Harvard at least $1.4 million in outside income from Johnson & Johnson and other makers of antipsychotic medicines.”

    The side effects of these medicines can also destroy lives. There’s a great deal of money to be made prescribing these drugs. Here’s a list of side effects for risperdal:

    “Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal thoughts; confusion; decreased sexual ability; drooling; enlarged breasts; fainting; fast or irregular heartbeat; fever; inability to control urination; increased sweating; missed menstrual period; new or worsening mental or mood changes (eg, aggression, agitation, severe anxiety); nipple discharge; prolonged painful erection; seizures; severe dizziness; stiff or rigid muscles; suicidal thoughts or attempts; symptoms of high blood sugar (eg, increased thirst, hunger, or urination; unusual weakness); tremor; trouble concentrating, speaking, or swallowing; trouble sitting still; trouble walking or standing; uncontrolled muscle movements (eg, arm or leg movements, twitching of the face or tongue, jerking or twisting); unusual bruising; vision changes.”

    This is just one drug. I know some families who have bipolar children, and I don’t think any of them are giving the children just one drug. Not only do the doctors not really know what the effects are on children, because no one’s ever studied the effect of antipsychotic drugs on children, they don’t know what the effects of drug interactions might be.