Questions and Controversies in Clinical Psychopharmacology

Questions and Controversies in Clinical Psychopharmacology

Mental health issues have become increasingly common today, affecting people of all ages. To some people, it would be difficult to fathom why a child should be diagnosed with a mental illness, especially considering that many such illnesses are caused by situational stresses. However, research has established that many of the major mental health disorders start during childhood (Preston, O’Neal & Talaga, 2010). Mental health issues in children form an important topic of study given the extent of impacts they have. According to Preston et al. (2010, p.243), mental disorders not only cause “considerable suffering in young children, but they can also markedly interfere with normal social and academic developmental experiences”. The authors add that certain psychiatric disorders could cause neurobiological impairment in the event that they are left untreated. On a rather different note, incidences of mental disorders among children have increased significantly, with statistics showing that at least 10% of children in the U.S. have been diagnosed as suffering from attention deficit hyperactivity disorder, thus being put on stimulant medications (Mayes, Bagwell & Erkulwater, 2008). Although pediatric use of psychoactive drugs is not a new phenomenon-it has been in place for close to four decades now, controversies have been raised regarding how safe these drugs are for children. More precisely, the administration of psychotic drugs to children suffering from mental disorders has been identified and discussed as a serious controversial issues in numerous scholarly journals.

Controversy in Psychopharmacological Treatment of Children

The controversy surrounding psychopharmacological treatment of children is a multi-faceted subject. According to Mayes et al. (2008), stimulant use among children is a controversial issue, the major reason being that the decision to test and put children on psychotics is made by parents together with clinicians. More precisely, “the treatment [for mental disorders in children] is ordinarily decided for them instead of by them, a scenario that invites criticism that a patient’s autonomy is being compromised to some extent” (Mayes et al., 2008 p.2). This is a very valid concern given that one of the guiding principles in health care is that professionals must strive to uphold autonomy of patients at all times.

It is not uncommon for parents together with clinicians to make decisions regarding the health of children. In fact, Mayes et al. (2008) report that a majority of medical decisions that involve children are determined by parents as well as clinicians and do not create any controversies. However, mental health is regarded as a different issue altogether. An explanation for this is that there isn’t a conclusive medical test that can be applied in verifying whether or not someone suffers from a mental disorder. On the contrary, the diagnosis of such disorders is based on inevitable subjectivity, and this leads to divergent definitions and views of what constitutes normal behavior in children (Mayes, Bagwell & Erkulwater, 2009). More importantly, an over diagnosis of mental disorders, notably ADHD, has been observed in the U.S., and this has led to overuse of stimulants (Mayes et al., 2009). At the same time, there are certain populations as well as areas in which an under-diagnosis of the disorder-and a resultant under-use of stimulants-have also been reported. These two scenarios pose serious consequences to personal as well as public health.

As highlighted earlier, one of the major controversies surrounding psychopharmacological treatment of mental health issues in children revolves around the principle of informed consent. As is typical of every controversy, there are conflicting views on this. Supporters of the administration of psychotic drugs on children with mental disorders offer a number of arguments to support their view. For example, it is argued that the society, in general, has an obligation of helping children suffering from emotional/behavioral disturbances. As such, it is expected that clinicians and medical social workers will focus on providing instantaneous help to the child without necessarily taking time to discuss the issue with the child (Parens & Johnston, 2008). This may be interpreted to suggest that seeking the child’s informed consent when addressing mental health issues in children is a waste of valuable time and could cause worsening of the condition.

Secondly, informed consent is perceived to be an elusive issue when dealing with mental health in children. In the words of Preston et al. (2010, p.244), “with children, there is no true informed consent since parents are the ones who usually make the decision whether or not to allow medication treatment”. A valid justification for this is that most children require supervision by their parents regarding taking drugs; lack of supervision can lead to overdosing or skipping the medications. To avoid this, it is only prudent that parents be the ones to decide if a child is to be put on psychotropic medications.

At the other side of the controversy are critics who strongly refute the idea of parents and clinicians making decisions regarding administration of stimulants to children with mental disorders. As already highlighted, the strongest counterargument to the idea is that it violates the patient’s right to autonomy. As is well known, every individual is entitled to make decisions about the kind of care that he/she wishes to get. Although it may be argued that children may not understand much about health to be allowed to make decisions regarding care, it is generally agreed among child clinicians that children above the age of seven years ought to be granted autonomy rights. Precisely, children above seven years ought to be involved in decisions on use of psychiatric medication. In so doing, the child is encouraged to raise any concerns that he/she may have regarding treatment (Preston et al., 2010). For example, many children believe that taking medicine is only for the crazy or very ill. To correct such misperceptions, it is important to include children in discussing different psychiatric medications.

Observing the principle of informed consent is also important as it helps in instilling positive attitudes towards mental health in children. It goes without saying that children who perceive their early experiences and encounters with psychotic drugs as positive will grow into adolescence and adulthood with positive views regarding treatment of mental health (Preston et al., 2010). This is very significant, given the fact that “many of the more severe disorders that warrant medical treatment during childhood are the first manifestations of what may be lifelong mental illnesses” (Preston et al., 2010 p.244). What this means is that when a child is included in decisions involving his/her mental health at a young age, he/she will most likely grow up being aware of what causes mental health issues, as well as signs to watch for. In short, he/she can become a mental health champion and an agent of much-needed change in the society. There is also the aspect of the child feeling respected, as well as the developing of a healthy relationship between therapists and children when informed consent is upheld.

Besides making decisions for children, use of psychotics generates controversies regarding safety. Preston et al. (2010) cite side effects of stimulants: anorexia, impaired concentration, insomnia, and death especially in instances where the stimulant is combines with an agonist. Similarly, the Food and Drug Administration agency reportedly warns against unchecked use of antidepressants by pediatric patients as this could lead to abnormal changes in behavior, violence, suicidality, and aggression (Meng, D’Arcy & Tempier, 2014). Safety concerns become an issue of concern when the aspects of over-diagnosis and under-diagnosis-highlighted earlier are factored in.

Relevance to Clinical Applications

With the issues described above, there is no doubt that that clinicians must review their prescription and administration of psychotic treatment on pediatric patients. More significantly, the analysis of the controversy of psychopharmacological treatment of children with mental disorders has vital implications for professionals in the area of social work and human services. To begin with, it must be understood by all healthcare professionals, including psychiatrists, that there are numerous factors that cause mental health disorders. As Preston et al. (2010) point out, there is a misperception among some parents that mental disorders are caused by chemical imbalance. Such a view is misguided as it ignores the psychological factors behind mental illness, such as dysfunctional family structures. In reference to this, social workers-as helping professionals-ought to be involved in analyzing and treating mental disorders in children so that the most appropriate treatment is given.

Secondly, the various facets surrounding the controversy of psychotics for pediatric treatment highlights the significance of embracing or rather incorporating integrative health in clinical practice. The National Center for Complementary and Integrative Health (2021) defines integrative health as the practice of using multimodal or multiple interventions with the aim of treating the person in his/her entirety rather than a single organ system. Integrative health comprises a range of interventions that include psychotherapy, conventional medicine, physical rehabilitation, and lifestyle changes among others. In this context, treating the person as a whole means helping individuals to improve their health from an environmental, biological, behavioral, and social perspective rather than merely treating disease (National Center for Complementary and Integrative Health, 2021).

Thirdly, it is time that clinicians, psychiatrists and the various professionals that are involved in handling mental health issues in children be properly trained on correct diagnosis of mental disorders. It is sad that most mental health diseases are usually wrongly diagnosed. One cannot possibly overemphasize the risk and danger posed by the fact that some children have severe mental health issues but do not get proper treatment, whereas others are receiving treatment for disorders that they do not have (Parens & Johnston, 2008). To correct this, it is crucial that child psychiatrics come into a consensus and drawn the boundary what constitutes a mental disorder and what can be considered normal behavior.

Moreover, clinicians and any other professional involved in treating pediatric mental disorders must observe ethics when prescribing medications. A specific recommendation by Roberts (2011) is that before giving psychotropic drugs to any patient, the individual’s history must be carefully reviewed and a methodical diagnostic evaluation conducted. For pediatric patients, this entails identifying the individual’s aspirations and biggest concerns together with motivations. This helps in prescribing antipsychotics only when necessary and supported by a firm evidence base.

Reconciling the controversy

Minimizing the controversy surrounding psychopharmacological treatment of mental health illness in children calls for the joint efforts of different practitioners. For mental health professionals, there is a lot that can be done to reconcile the controversy. To begin with, mental health professionals can participate in researching the reasons behind the inaccurate diagnosis of mental disorders in children. Mayes et al. (2008, p.3) disclose that “it is not clear to clinicians, researchers or the general public if ADHD is primarily a medical disorder, a behavioral problem manifesting primarily in schools, a mental illness, or an evolutionary disorder of human adaptation”. To help clear this dilemma, these professionals may contribute by interacting with the populations or areas where mental disorder cases involving children are high. This way, they will get to study the contributory factors, thus helping to get a clearer picture of the whole situation.

Mental health professionals can also help to reconcile the controversy surrounding psychopharmacological treatment of mental health issues in children by educating patients and clinicians about the importance of involving children. As has been stated, most of the decisions to put children with mental disorders on psychotropic drugs are made by parents together with clinicians, excluding the children. The benefits of involving the pediatric patients have already been outlined; and this indicates the usefulness of mental health professionals in promoting implementation of the concept of informed consent and the principle of autonomy.

Given their specialty, mental health professionals may also help to reconcile the controversy by taking part in reviewing policies relating to prescription of psychotropic medications. Crystal et al. (2009) note that striking a balance between the merits and demerits of antipsychotic medications is a challenging task for clinicians together with patients. This, according to research, is because alternative treatments that are effective are scarce to find (Kolch et al., 2010). For example, the effectiveness of atypical antipsychotics in children suffering from mental disorders is yet to be established, with reports showing that such medications can have detrimental impacts on a child’s metabolic functioning (Crystal et al., 2009). Since mental health professionals have a good understanding of the benefits and risks of the various interventions, they should be actively involved in administering medication to patients.

Mental health professionals should work in collaboration with physicians to reconcile the controversy, specifically by advising physicians on which drugs or interventions are most appropriate. As it is, physicians have the greater voice on these matters, going by the report that family physicians play a significant role in the prescription of antidepressants (Meng et al., 2014). Clearly, something needs to be done about this, more so given that physicians typically encounter challenges regarding proper use of powerful medicines such as antipsychotic drugs. A major challenge is the lack of enough data about the long-term safety as well as comparative effectiveness of different treatments (Crystal et al., 2009). Mental health professionals can come in handy here by developing policies and guidelines on appropriate, safe medication combinations.

To address the issue of wrong diagnosis and undertreatment as well overtreatment of pediatric mental health issues, mental health professionals should play a leading role in conducting an inventory of mental health resources within the community. According to Foy, Perrin and the (2010), unavailability of referral facilities is cited by primary care physicians as a key obstacle to effective treatment of mental health illnesses in children. In some instances, clinicians are not aware of specialty resources within the community. In an ideal situation, every community has a directory listing available services for mental health. Where it is established that such directories do not exist, mental health professionals should take the initiative and provide directions on where clinicians can find specialty resources.

Lastly, having established that mental health illnesses are caused by a horde of factors that may include dysfunctional family structures, it is important that mental health professionals teach entire families about the topic. Foy and the American Academy of Pediatrics Task Force on Mental Health (2010, p.110) urge mental health professionals to “normalize conversations about mental health and substance abuse to communicate the importance of children’s mental health”. In the context of this paper, this is crucial given the finding that in many cases, children are left out of discussions and decisions involving their mental health. Equally important, such conversations will help correct the misperception by parents that psychotropic medications are a quick fix to mental health issues in children as they correct the chemical imbalances that trigger these issues.

Conclusion

The growing prevalence of mental health issues in the society today is a worrying trend that necessitates urgent action to develop a lasting solution. Concerns about mental health have become an important topic that has captured the attention of scholars and researchers across the world. A rather disturbing observation made by researchers is that mental health illnesses affect individuals across all age groups, children included. As part of treatment, children have been introduced to psychotropic medications, an issue that has generated controversies. As identified in the paper, the controversy surrounding administration of such medications to children is multi-faceted, with concerns about how safe such drugs are to children, as well as how ethical it is for clinicians to go ahead and prescribe medications without the child’s consent. A shocking finding made in this paper regarding psychopharmacological treatment for children with mental disorders is that cases of under-diagnosis and over-diagnosis are not uncommon. On the same note, it has been learnt that a significant number of children are given antipsychotic medications yet they do not need the, while those that desperately need them may not access them (Parens & Johnston, 2008). Without doubt, these findings raise questions on the appropriateness of psychotropic medications for children. To address this issue and reconcile the controversy, mental health professionals are strongly encouraged to work together with clinicians and healthcare professionals towards making sure that pediatric mental health issues are correctly diagnosed and appropriately treated. At the same time, mental health professions should liaise with social workers and other medical health professionals to provide sensitization and awareness on mental health, especially the significance of involving children in decisions that affect their health. This latter recommendation is based on the common knowledge that engaging beneficiaries of a proposed solution in developing the solution increases its effectiveness by substantial margins.

References

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