Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 54

One of the greatest changes in the field of abnormal child psychology in the past 2 decades has been the increased use of psychotropic medication—that is, prescription medication used to treat behavioral, cognitive, or emotional problems. Approximately 7.5% of all school-age children and adolescents are taking at least one psychotropic medication at any point in time (Howie, Pastor, & Lukacs, 2014; Jonas, Gu, & Albertorio-Diaz, 2013).

The use of psychotropic medication varies as a function of children’s age (Figure 1.3). Medication is more frequently prescribed to adolescents than to prepubescent children. The greater use of psychotropic medication among adolescents likely reflects the greater overall prevalence of mental health problems in adolescents compared to younger children. Furthermore, adolescents’ mental health problems tend to be more severe and, consequently, may be more likely to require medication. Although young children are less likely to be prescribed medication than older children and adolescents, approximately 2% of preschoolers are taking at least one medication to manage a mental health problem (Chirdkiatgumchai et al., 2013; Fontanella, Hiance, Phillips, Bridge, & Campo, 2014).

Medication use also varies by gender. Regardless of age, boys are more likely to receive medication for psychological problems than girls. This gender difference in medication use reflects the fact that boys are approximately 3 times more likely than girls to be diagnosed with ADHD and to receive medication for that condition.

The percentage of youths receiving medication to treat psychological problems has more than doubled over the past 20 years. Interestingly, the percentage of children participating in psychotherapy, a nonmedicinal treatment, has remained relatively stable during this same time period (Olfson, Blanco, Wang, Laje, & Correll, 2014; Olfson, He, & Merikangas, 2013).

Two factors seem to be driving the overall rise in the use of psychotropic medication among children and adolescents. First, clinicians are getting better at recognizing mental disorders in youths. Second, physicians have more medication options for children now than 2 decades ago (Bowers, Weston, Mast, Nelson, & Jackson, 2020).

Interestingly, not all types of psychotropic medications have shown the same increase in popularity. Medications used to treat ADHD, such as Ritalin and Adderall, showed a dramatic increase in the past 2 decades. In contrast, medications used to treat anxiety disorders (i.e., anxiolytics) and thought disorders like schizophrenia (i.e., antipsychotics) have increased at a slower pace. Only one class of medication for children and adolescents has declined in popularity: antidepressants. In the 1990s, physicians began prescribing antidepressant medications, like Prozac, to youths with depressive symptoms. In 2004, however, the US Food and Drug Administration (FDA) issued a warning to physicians that youths prescribed antidepressants were significantly more likely to experience suicidal thoughts (4%) than youths with depression who took placebo (2%). Because of this warning, antidepressant prescriptions declined. Today, antidepressants are usually reserved for youths who show more serious depressive symptoms and who are not showing adequate improvement in psychotherapy (Friedman, 2014).

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Figure 1.3 ■ Medication Use by Children and Adolescents

Note: Approximately 7.5% of youths use psychotropic medications at any point in time. Boys are more likely to use medication than girls and adolescents are more likely to use medication than prepubescent children (Howie et al., 2014).

Is medication overprescribed? To answer this question, researchers examined psychological problems and medication use in a large, nationally representative sample of adolescents (Merikangas & He, 2014). In the previous year, approximately 40% of adolescents experienced a mental health problem. However, only 14.2% of adolescents with mental health problems were prescribed medication. These findings challenge the widespread belief that psychotropic medication is overprescribed to youths. On the contrary, many children and adolescents who might benefit from medication never receive it.