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Introduction
Purpose
This paper seeks to address the sharp increase in the use of psychotropic medications among children. The paper will review various articles to analyze the contributing factors based on the pediatric psychopharmacology literature that explores the increased awareness of various health issues among children and the establishment of intervention measures that are viewed as safer as compared to that of adults. This paper will also evaluate controversies in clinical management to establish the way forward to finding sustainable solutions and make recommendations.
Significance
The current trends in the field of medicine have been purely evidence-based, thus, compelling health practitioners and child welfare advocates to involve in a keen assessment of the danger and significance of applying psychopharmacological interventions in young children. Much attention on this issue has accumulated, thus, causing a strong wave of curiosity and confusion. This attention seeks to identify if the ongoing application of psychotropic products is undertaken appropriately to eliminate bad impulses and feelings among children. The proper use of these treatments should consider potential effects on neurological growth, personality development, and behavior (Alavi & Calleja, 2012).
However, suspicions persist that this pattern may be facilitated by a profit-induced demand generated by drug companies and unscrupulous medical practitioners. Despite the increased awareness about the use of psychotropic drugs in the United States, cases of overuse of such medications among children persist. This clinical misappropriation has the potential of exacerbating careless or hazardous treatments and lead to unwanted health care costs.
Meanwhile, the prescription of psychotropic drugs to reduce emotional and behavioral challenges among children in the U.S has been on the rise in the recent past. These medications have been used widely to treat children with mental problems. However, studies indicate that when applied properly, psychotropic medications can be very beneficial (Huefner & Griffith, 2014). On the other hand, the overuse of such drugs has proved detrimental to young children regarding severe side effects.
Unfortunately, today, most young patients receive medications without being assessed using evidence-based procedures. Most Americans visit their physicians and receive medications without being evaluated using cognitive behavioral therapy that might be effective. This trend can be linked to the low level of collaboration between mental health care workers and the patient population.
Following the increased awareness of critical mental health challenges among children, society has increased its expectations based on the improved experience of practitioners. Even though this field has made profound progress in managing adverse psychiatric problems amongst young children, relying solely on pharmacological interventions might worsen the situation. Thus, the need for an evidence-based and thoughtful plan for the application of psychotropic drugs with young children is inevitable.
During a review of advancements in pediatric psychopharmacology, Shelton, Ehret, Wakai, Kapetanovic, and Moran (2010) identified that psychiatric problems are likely to be more pronounced and unresponsive to treatment if their emergence coincides with childhood as compared to old age. Sharma et al. (2016) backed these claims by showing that psychiatric disorders are related to severe functional impairments if they emerge during young age.
Although this aspect may explain why critically ill children should be given psychiatric drugs, it does not warrant overtreatment or address claims about treatment inefficacy. Zakriski, Wheeler, Burda, and Shields (2005) posit, “Extensive prescription of psychotropic drugs among children should be understood in relation to the evolving mental health sector” (p. 19).
Scope
This paper will evaluate the contemporary literature on the overuse of psychotropic medication among children. This milestone will be achieved by exploring various sub-sections including issues in clinical managerial operations, cautionary measures for increased use of psychotropic drugs, and drug influence on nervous system development. This paper will also explore the context for prescribing psychotropic drugs as well as critical stages in treatment when such medications are used.
The focus will be mainly on mental health among children in foster care. However, treatment measures that do not entail the use of psychotropic drugs will not be addressed. Similarly, psychotropic treatment for patients above the age of 16 years will be excluded. This paper will conclude by providing recommendations for managerial considerations towards ensuring effective psychiatric health care provision.
Terms
- Psychotropic medicine – These are drugs prescribed to improve the socio-emotional and behavioral well-being of a young child suffering from a mental health problem (Hieber, 2013).
- Bio – Bio defines physical wellbeing as well as genetic composition. According to Nguyen and Shapiro (2015), psychotropic drugs influence biological factors by changing the concentrations of chemicals in the brain that assist in managing the functioning of brain cells that define emotions.
- Psycho – Psycho defines the psychological aspects of the children that influence emotional and behavioral changes such as feelings and thoughts.
- Social – Social describes the environmental issues that contribute to a child’s functioning. These environmental factors include child welfare services, family relationships, and natural support (Kalikow, 2008). Natural support comes from peers, friends, and the mainstream community.
- Foster care – Foster care entails placing a minor in a care facility, or private home of a legally certified caregiver. The goal of foster care is to provide services and opportunities that a child had been previously denied through either neglect or fate (Raghavan & McMillen, 2008).
- Polypharmacy – Polypharmacy entails administering two or more psychotropic drugs at once. This situation occurs when a patient is diagnosed with more than one psychiatric condition. Besides, some conditions need to be enhanced by a second medication particularly when treatment is not working.
- Psychopharmacotherapy – This term refers to the management of mental health problems such as bipolar disorders or post-traumatic stress disorders (PTSD).
Literature Review
This section is a review of the contemporary findings of the overuse of psychotropic medications among children and particularly in the United States. Findings of about fifteen articles will be reviewed to shed light on this controversial topic. In preparation for developing this paper, articles providing information regarding child-serving agencies will be assessed in depth. The literature review targets to address the areas as outlined in this chapter.
Since this field has been changing drastically, the available literature may not be sufficient, and thus, data from domestic organizations that serve psychiatric issues among children will be considered. Research on managerial operations including the influence of their decisions on this field will be highlighted. Finally, a summary of the best practices in the area of psychotropic medication among children will be reviewed.
Psychotropic Cases and Medications among Children
According to Memari, Ziaee, Beygi, Moshayedi, and Mirfazeli (2012), psychotropic medication is prescribed to promote the emotional and behavioral well-being of the patient suffering from a mental disorder. These scholars claim that psychotropic drugs have been over or under-prescribed for young children, thus, calling for more research in this area. Therefore, prescribing psychotropic drugs for children needs an experienced practitioner with expertise in the application of such medications to young ones.
Appropriate medication eliminates psychologically-based impediments to change by facilitating the child’s efforts to be more significant. Besides, prescribing psychotropic medication highly depends on the context that the prescription occurs. Many children benefit highly from psychotropic medication if it occurs in a comprehensive treatment approach. Such an approach can allow children to utilize community intervention plans while in their homes and learning institutions.
The overuse or misuse of any form of medication has been associated with various side effects. Side effects fall into three classifications namely minor, medium, or severe. The minor side effects include headaches and nausea. The medium ones include the lack of appetite, restlessness, and concentration among others. On the other side, severe side effects include overweight and deformations among young children.
Various issues can lead to the overuse of drugs including poor prescription or failure to follow prescription orders. Some prescribers may initiate polypharmacy when more than two psychiatric conditions are detected. Initiating more than one medicine is not recommendable because it might be challenging to identify the medicine that is beneficial or lead to side effects (McMillen, Fedoravicius, Rowe, Zima, & Ware, 2006).
In spite of the limited skills among providers, there has been a lot of pressure to prescribe due to the severe cases among the youth. This pressure has contributed to either under or over-prescription. Consequently, serious side effects have been manifested, thus, compelling caregivers to seek alternative ways to medicate. The benefits gained from medication should be assessed against the potential risks before deciding if a drug should be used. Parents and legal custodians should be enlightened concerning the possible risks, benefits, and loopholes in medication before introducing psychotropic medications.
Children in Foster Care
Currently, the American public health care sector is facing an emerging pattern where children in foster care have become more exposed to unscrupulous drugs and over-prescription of psychotic medications (Longhofer, Floersch, & Okpych, 2011). This patient population has an array of emotional and psychological needs arising from the environment that they have experienced in the past. For example, children in foster care might have typically undergone child abuse in neglectful or conflicting backgrounds.
These chaotic caregiving settings are often associated with posttraumatic conditions that have the potential of causing severe mental disorders. Research work by Sharma et al. (2016) indicates that being in foster care increases the probability of inappropriate administration of psychotropic medications. This study supports its claims by indicating some factors that contribute to this misappropriation. These factors include being needy, in a population of psychiatric patients, and institutionalized.
In most states in the US, children in foster care using psychotropic drugs must seek the permission of a caregiver. This provision seeks to address the increasing cases of overuse and misuse of psychotropic drugs among children. Unfortunately, the state continues to face cases where psychotropic medication is administered in the absence of the needed legal consent. Care providers, as well as foster child activists, view this aspect as a critical area that requires adequate attention. Strict measures need to be put in place given the significance of psychotropic drugs when prescribed appropriately (Raghavan & McMillen, 2008).
It is important for the legal caregivers to familiarize themselves with the child’s emotional needs, the intervention measures being used, as well as the predicted outcomes. However, some of the foster care facilities indulge in fraudulent deals with pharmaceutical companies targeting children in foster care. Apparently, there is a growing misconception that children in foster care desperately need psychotropic drugs. This perception is not always true, but it has been used to overprescribe psychotic drugs to children for purposes of making a profit. Besides, not all children in foster care need to use psychotic medication for therapeutic purposes. Therefore, professional assessment should be done before prescribing any psychotropic medication to children.
Managerial Operations and Strategies for Addressing drug overuse
Several key areas of psychopharmacological treatment continue to raise concerns among researchers as matters of significance to providers. As indicated earlier, the field of psychotropic medication among young children continues to face a lack of congruent evidence. This problem is compounded by the lack of proper decision-making towards reliable and sustainable psychiatric therapy among young children.
One of the major controversies that need to be addressed is the question of the long-term perspective reliability of psychotropic drugs among young populations. Potukuchi and Li (2013) emphasize that in most cases, post-traumatic stress-related disorders continue to manifest in most children during development. This assertion implies that most children experiencing mental health challenges will still use psychiatric medications in their later years.
Besides, most psychiatric drugs are not prescribed by weight, as is the case with other pediatric prescriptions. This situation puts children in need of psychiatric attention at the risk of over-prescription. Therefore, when giving children such drugs, the prescribers should start with small dosages and proceed gradually to ensure safety in consumption.
Another managerial controversy that needs to be addressed in pediatric care revolves around the treatment of depression in children. A study by Nguyen and Shapiro (2015) suggests that practitioners addressing depression among young children lack comprehensive training and skills in behavioral science. Consequently, these care providers might fail to identify the disorders correctly as manifested by their patients.
Despite this lack of critical knowledge and compromised comfort level of prescribing different psychiatric conditions, most providers do not hesitate to diagnose mental disorders. Due to this evident shortage of skilled providers, it is necessary for organizations to ensure appropriate and continued training for child psychiatrists. Besides, the issue of continued care and progress tracking of the mental condition among children is a matter that should be prioritized by the management.
Education and training
Education should target creating awareness for the children, families, and most importantly the prescribers. Education and training promote a shared understanding of treatment goals and responsibilities. Cooperation is promoted when there are common goals and clarity concerning each stakeholder’s role. Organizational training improves communication skills. Effective communication is the main factor in collaboration and building sustainable relationships between patients and pediatrics (Longhofer et al., 2011).
When all involved parties have an adequate level of education, there is ease in decision-making, and the consensus is easily attained. Enhancing knowledge for the children and families enables appropriate decision-making when choosing mental health care services.
Enhancing the quality of mental health care relies on the informed cooperation of all mental health care providers in ensuring evidence-based care for the young population. Increasing education and training may assist in the reduction of the chances of overuse and risk of antipsychotic drugs. Besides, drug companies are compelled to avoid bad practices since people are aware of the agenda to make a profit.
Flexibility in professional roles
As it has been evidenced in the psychopharmacology practice, to achieve quality mental care requires the review of professional responsibilities. This review should focus on shifting of roles and the expansion of skills to cover emerging mental health care issues. Health care workers should be trained to possess the diverse knowledge, which is requisite in resolving new tasks brought by developments in medication, insufficiency of health care providers, and the need to optimize resources. However, changes in roles are not easy, and it is often uncomfortable for mental health care providers. Consequently, it is essential to offer education and training in flexibility and cooperative skills to avoid role confusion and conflict.
Leadership
Good leadership is widely recognized to be a significant aspect of the prosperity of any quality improvement plan and a necessary factor in mental health care coordination. Good leadership helps in the shaping of the personalities that are in line with an organization’s culture and goals. Organizations that have the right leadership are less likely to engage in unethical practices. On the contrary, they are responsible for securing the needed care, ensuring abidance to health care standards, and promoting patient satisfaction through collaborative practice.
Issues in Psychopharmacotherapy Practice
The prescription of psychotic drugs has spiked mainly due to the increased awareness of mental health challenges among children. Unfortunately, the system is not always prepared to abide by the best practices. Drug companies have chosen to overestimate the benefits of these drugs without indicating the potential risks. During the last three decades, the Food and Drug Association (FDA) has approved various antipsychotic medications for use amongst children suffering from schizophrenia or bipolar disorder. Unfortunately, studies indicate that most of the children given antipsychotic medications do not use them to eliminate one of those disorders (Loewit-Phillips & Goldbas, 2013).
According to Huefner and Griffith (2014), schizophrenia is mostly associated with adulthood while bipolar disorder is approximated to influence about 3 % of children. However, practitioners continue to prescribe antipsychotic drugs for other reasons including disruptive behavior or post-traumatic stress disorder. Behavioral problems affect a large population of children during adolescence. Consequently, children are given these drugs by their pediatricians instead of a psychiatrist.
Medication Influence on Neural System Growth
Despite the increased research on the influence of psychotic medication among young children, there is still insufficient knowledge about the long-term consequences of these drugs. There are no evidence-based studies to highlight the potential effect of these drugs on growing organs, the brain, and the nervous system. Nonetheless, in a review of psychopharmatherapy practice, Kalikow (2008) suggests that psychotropic drugs have a potential risk of the development of the central nervous system, particularly when patients are overprescribed. Thus, overdose or chronic exposure to psychotic drugs has the potential to cause developmental deformations in children.
Summary
The findings in these reviews clearly indicate that children in foster care, as well as those in other support services, require careful monitoring to ensure that the administration of psychoactive is within the required limits. Prescribers working for childcare services should be aware of the possible abuse of psychotic drugs in this patient population. Thus, it is vital for these prescribers to assess the profiles for the affected children for any signs of adverse consequences, overdose, prolonged use, and sufficient evidence for a prescription.
Reaching children in foster care might be hard, and thus, proper prescription review before medication and training of providers can assist in the elimination of the abuse of psychotropic drugs in this patient population.
Furthermore, drug companies have used the loopholes in the medical research about the use of psychotropic drugs to maximize profits by targeting the young patient population. Therefore, the state government should review laws and administrative practices to eliminate all loopholes that propagate misinformation between drug companies and the patient population. Administrative practices in the mental health sector should provide leadership collaboratively to eliminate all possibilities of fraudulent activities (Hieber, 2013).
Recommendations
Due to the need for scientific data on psychiatric conditions, further research on this field must offer guidelines identifying precise assessment procedures. Second, there is a need to build accurate benefit and risk estimates associated with psychotropic medication among the affected children. Current studies are yet to offer consistent reports about the exact benefits or risks linked to certain drugs. Third, there is a need to conduct more research to build knowledge on the impact of high concentrations of psychotropic drug exposure during early childhood development.
A clinical study based on these factors is vital if the US is to achieve a sustainable psychopharmacological practice. Besides, more insights will support the increasing need for personalized medication, particularly among the young population. Some of the principles that can be implemented by the managers or organizations for optimal psychomacotherapy practice include the following.
- Before introducing a patient to psychotropic medication, an evidence-based evaluation must be conducted.
- Evaluation results should be supported by a medical history before introducing children to psychiatric therapy. The prescriber should liaise with any professionals involved with the patient to get a historical background. Children are very sensitive, and thus, great care should be taken when introducing psychomacotherapy.
- The prescriber should create a plan to ensure follow-up exercises and determine the efficacy of the medication. Therefore, prescribers must be keen when initiating a treatment approach that cannot be tracked accordingly.
- The consent discussion should not encourage prescribers to engage in malicious activities. On the contrary, it should focus on the risks and benefits of the treatment plan.
- The prescriber should reassess the child if s/he does not respond to the first treatment. Besides, the prescriber must offer a justification for initiating medical combinations.
- Finally, discontinuing medication needs an elaborate plan to avoid relapse.
These principles are essential for safe and reliable intervention, and they should assist in the prevention of medical malpractices targeting to over-prescribe drugs for profit-making. These reliable principles should further protect patients against initiation to unnecessary changes in psychiatric treatment to prevent the overuse of pharmacological treatment procedures among children. Besides, these principles should motivate the affected children and families experiencing inappropriate treatment to desist from dropping out, but rather show concern for quality treatment in the future.
It is necessary for the parent of the affected child, legal custodian to find an alternative treatment plan if there are serious side effects, or no improvements are observed. Various cases may indicate the need for an alternative plan. Such scenarios may involve weight gain, particularly when drugs are used for a long time. Parents or custodians should not hesitate to consult their primary prescriber before seeking an alternative treatment plan. The primary prescriber should collaborate with the parent in seeking and informing the alternative plan. Prescribers of psychotropic drugs to children must be licensed to administer coupled with being exposed to continued learning to stay aware of the evolving benefits and risks linked to the use of such medications (Fontanella, Hiance, Phillips, Bridge, & Campo, 2013).
However, these milestones cannot be stated and achieved without action. Collaboration and coordination among children, families, and providers must be enhanced. The patient or the parents should be made aware of all communications and interactions aimed at providing care. Continued sharing of information regarding the patient’s needs and progress is essential to avoid unintended overuse or prolonged use of drugs. Since children are actively involved in many programs, it is necessary for prescribers to coordinate their activities with those of different institutions such as schools.
Lessons Learned
I have established various reasons behind the antipsychotic boom among the young population in the United States. Based on a study by Alavi and Calleja (2012), highly aggressive marketing behavior involving prescribers in fraudulent deals is a key determinant for the overuse of these drugs. Due to the lack of quality mental health services, poor families have been caught in this wave of substandard prescriptions. Similarly, children in foster care have fallen victims due to the lack of enough resources to deal with critical emotional and psychological challenges. Based on these challenges, I have identified that there is a societal mindset to seek a quick fix to rectify abnormal traits.
Based on contemporary literature, over-prescription is not a mistake, particularly when prescribing to children in foster care. Huge profits are made in prescribing drugs to children particularly when those drugs are meant to be used for a long period. I have realized that the long-term effects of the overuse of psychotropic drugs are yet to be clarified. Children under foster care have been identified as the most affected as opposed to other children under regular care or Medicaid. However, this trend is largely influenced by pharmaceutical companies. Drug companies target practitioners at the foster care facilities and lure them to prescribe more medications with an intention of making a profit.
Further Research/Questions
Psychotropic drugs play a critical role in psychiatric management among children. However, for children taking psychoactive medications, the demerits tend to be more than the merits, particularly when an evidence-based evaluation is overlooked. This trend is very worrisome given that very little is known regarding the long-term effects of using these drugs. Therefore, further research should focus on determining the possible long-term effects among the young patient population. Besides, studies should focus on revealing the reasons behind the antipsychotic drug boom and identify lasting intervention measures.
Further research should also focus on answering questions such as if these drugs help. Fontanella et al. (2013) suggest that even for the approved purposes such as schizophrenia and bipolar disorder, it is uncertain to what extent the drugs are effective and if they can be reliable in the long-term. The second issue that should be addressed touches on the safety of these medications. Following the increased awareness of psychiatric conditions among children, drug companies have taken advantage of this multi-billionaire industry.
It has become very hard to determine the genuine version of antipsychotic drugs. Besides, there is little research to determine the safety level of the conventional versions endorsed by the FDA. Third, it important to determine what happens when medications are combined coupled with the safety of this practice. Despite the fact that doctors prescribe more than one drug at the same time, very little is known regarding the outcome of this practice.
Summary
The ongoing dissemination of childcare practices and the substantial research in psychopharmacological practice may assist in the intervention of over-prescription among children with mental problems in the US. Ideally, the task of ensuring that young children are prevented from medical malpractices requires a sustainable approach where children can access evidence-based mental health. Practitioners need to acquire vital skills and abide by the ethics that discourage any form of medical malpractice. Since mental health care spreads out to cover various stakeholders, it is necessary to forge relationships among families, psychiatrists, and primary care providers to deliver evidence-based care.
Further research, education, and training are needed in this field. Quality education is the key to effective collaboration that seems to be lacking in the current system. Drug companies continue to benefit from the poor relationship between prescribers and patients by using the latter to give more drugs regardless of the risk. When people are enlightened and forge collaborations with prescribers, there will be an increased need for evidence-based practices to eliminate bad practices. Given the increased cases of psychiatric cases in the US, the search for more evidence-based health information on pharmacological practice is needed urgently.
References
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Fontanella, C., Hiance, D., Phillips, G., Bridge, J., & Campo, J. (2013). Trends in psychotropic medication use for Medicaid-enrolled preschool children. Journal of Child and Family Studies, 23(4), 617-631.
Hieber, R. (2013). Toolbox: Psychotropic medications approved in children and adolescents. Mental Health Clinician, 2(11), 344-346.
Huefner, J., & Griffith, A. (2014). Psychotropic medication use with troubled children and youth. Journal of Child and Family Studies, 23(4), 613-616.
Kalikow, K. (2008). Psychiatric medications for children. Psychiatric Times, 25(13), 18-19.
Loewit-Phillips, P., & Goldbas, A. (2013). Psychotropic medications for the nation’s youngest children. International Journal of Childbirth Education, 28(1), 32-37.
Longhofer, J., Floersch, J., & Okpych, N. (2011). Foster youth and psychotropic treatment: Where next. Children and Youth Services Review, 33(2), 395-404.
McMillen, J., Fedoravicius, N., Rowe, J., Zima, B., & Ware, N. (2006). A crisis of credibility: professionals’ concerns about the psychiatric care provided to clients of the child welfare system. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 203-212.
Memari, A., Ziaee, V., Beygi, S., Moshayedi, P., & Mirfazeli, F. (2012). Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: Perspective from a developing country. Research in Developmental Disabilities, 33(2), 563-569.
Nguyen, M., & Shapiro, M. (2015). Topiramate for weight loss in children and adolescents prescribed psychotropic medications. European Psychiatry, 30(1), 694-702.
Potukuchi, P., & Li, C. (2013). National trends in psychotropic medications use among children with attention deficit hyperactivity disorder (ADHD) in the United States. Value in Health, 16(3), 56-57.
Raghavan, R., & McMillen, J. (2008). Use of multiple psychotropic medications among adolescents aging out of foster care. Psychiatric Services, 59(9), 1052-1055.
Sharma, A., Arango, C., Coghill, D., Gringras, P., Nutt, D.,…Hollis, C. (2016). BAP position statement: Off-label prescribing of psychotropic medication to children and adolescents. Journal of Psychopharmacology, 30(5), 416-421.
Shelton, D., Ehret, M., Wakai, S., Kapetanovic, T., & Moran, M. (2010). Psychotropic medication adherence in correctional facilities: a review of the literature. Journal of Psychiatric and Mental Health Nursing, 17(7), 603-613.
Zakriski, A., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable psychopharmacology or overzealous prescription? examining parental reports of lifetime prescription histories of psychiatrically hospitalized children. Child and Adolescent Mental Health, 10(1), 16-22.
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