The Great Divide

What are we going to do about the increasing number of children diagnosed with “mental health” disorders?

I put quotations marks around this phrase because I’m not sure “mental health” and “disorders” captures the whole picture. First of all, I strongly believe that depression, bipolar disorder, anxiety, ADHD, and autism all have genetic/biologic components and environmental triggers, and that “mental health” doesn’t describe the scope of the problem accurately. Historically, mental health or psychiatric disorders have been looked upon as unsolvable riddles, unworthy of serious study and medical treatment. As the 1970’s ushered in a new era of pharmacological solutions to these syndromes, at least in adults we began to view these disorders as treatable with biological solutions. And yes, many individuals have benefitted from this revolution (as have several large pharmaceutical companies).

But to this day, autism and other complex medical disorders are frequently diagnosed (oh, we’re getting good at that) but poorly treated. In fact, it’s still a sin in some circles to suggest that autism IS treatable. And the number of children diagnosed with bipolar disorder and other serious conditions is skyrocketing. I am concerned that we are seeing a rise in rates in large part due to a child-environment mismatch. I mean this in several ways. Make no mistake – there is a real increase in the number of children diagnosed with these conditions. This is not simply “better” diagnosis or diagnostic substitution (i.e. what used to be “mental retardation” is now “autism spectrum disorder”). No, I think we are creating home and school environments, perhaps even a whole world, in which we are increasing stress and biopsychological shifts in our children to the point of visible distress. Should we not be creating habitats that fit our individual children more effectively? Would this not be kinder? No, we push and push and expect more and more in less time. We try to fit full-day kindergarten into half-day programs and then shoe-horn after-school activities between school and dinner, then expect homework to be done, and then off to bed we go (hopefully). Though a rise in sleep disorders is without a doubt a by-product of this abandonment of down-time. Furthermore, there is mounting evidence that environmental factors, including toxin exposures, are contributing to the rise in neurodevelopmental disorders. A recent review by Drs. Grandjean and Landrigan in Lancet is a loud call-to-arms, supported by research in the journal Environmental Health Perspectives (among others) connecting ADHD to tobacco and lead exposures.

A front-page New York Times series last week detailed the nature of the problem in the U.S. Various families are quoted about how much they and their kids as suffering, and about how little help there is for them. In part two, various psychiatric experts were paraded out to debate the safety and efficacy of pharmacologic cocktails more and more commonly used to treat this disorders. What’s very clear is this: there is a growing divide between the scope of the problem and our ability to deal with it. As the title of the NYT piece (November 23) says: ” Proof is Scant…” It is troubling to me that we, as a society, keep pushing the envelope and spending millions of dollars on medications with serious side-effects (including heart and liver damage – though thankfully, rare), while we disparage gentler solutions like mind-body therapies to reduce stress. I’m not suggesting we abandon research efforts in pharmacologic treatments for psychiatric conditions – I’m simply asking for a level-playing field, especially for children. Children suffer an inordinate and unexpected array of ill-effects from medications. Witness recent reports about severe neurological reactions to a commonly-prescribed flu medicine, Tamiflu. We should be spending equal effort, and affording equal consideration, to research efforts in CAM therapies for children’s “mental health” disorders. There is already strong evidence supporting meditation for reduction of stress in high-risk adolescents. And there is new research supporting the use of omega-3 fatty acids in childhood depression and in autism spectrum disorders. Of course, every parent can also attest to the power of healthy lifestyle factors as well – nutrition, exercise, and rest.

Thankfully, most children do not suffer the extreme versions of bipolar disorder, depression and autism presented in the recent media stories; instead they suffer occasional bouts of anxiety and irritabilty. Yet I think the children portrayed in these articles are the proverbial canaries in the coal mine – and we must heed their warnings, now.