{"id":2690,"date":"2010-09-07T07:10:00","date_gmt":"2010-09-07T02:10:00","guid":{"rendered":"http:\/\/www.policymed.com\/new-york-times-pediatric-mental-health-diagnosis-deficiencies-continuing-medical-education-could-hel\/"},"modified":"2018-05-05T01:04:29","modified_gmt":"2018-05-04T20:04:29","slug":"new-york-times-pediatric-mental-health-diagnosis-deficiencies-continuing-medical-education-could-hel","status":"publish","type":"post","link":"https:\/\/www.policymed.com\/2010\/09\/new-york-times-pediatric-mental-health-diagnosis-deficiencies-continuing-medical-education-could-hel.html","title":{"rendered":"New York Times:  Pediatric Mental Health Diagnosis Deficiencies &#8211; Continuing Medical Education Could Help"},"content":{"rendered":"<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"font-family: Arial;\">A recent story in the <\/span><a href=\"http:\/\/www.nytimes.com\/2010\/09\/02\/business\/02kids.html?_r=2&amp;ref=health\"><span style=\"font-family: Arial;\">New York Times<\/span><\/a><span style=\"font-family: Arial;\"> discussed the difficulty doctors are having diagnosing children who have behavioral problems, especially when they appear at young ages. The article focused on a young boy, who at the age of 18 months, was being seen by different doctors, being diagnosed with numerous conditions, and then being placed on a number of medications.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"font-family: Arial;\">Eventually, the family and the boy enrolled into a program <span style=\"color: black;\">aimed at helping low-income families whose children have <\/span><\/span><a title=\"Recent and archival health news about mental health and disorders.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/mentalhealthanddisorders\/index.html?inline=nyt-classifier\"><span style=\"color: #004276;\"><span style=\"font-family: Arial;\">mental health<\/span><\/span><\/a><span style=\"font-family: Arial;\"><span style=\"color: black;\"> problems. Through this program, the boy\u2019s doctors gave him a more common diagnosis for children of attention-deficit hyperactivity disorder, which the author believes is proof that he should have never been prescribed such powerful drugs in the first place. <\/span><span style=\"mso-spacerun: yes;\">\u00a0<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 12pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">In fact, she points to medical records the mothers boy provided to the <em style=\"mso-bidi-font-style: normal;\">Times <\/em>\u201cto help document a public glimpse into a trend that some psychiatric experts say they are finding increasingly worrisome: ready prescription-writing by doctors of more potent drugs to treat extremely young children, even infants, whose conditions rarely require such measures.\u201d <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">For example, the author points out from a September 2009 report by the <\/span><\/span><a title=\"The F.D.A. report.\" href=\"http:\/\/www.fda.gov\/downloads\/AdvisoryCommittees\/CommitteesMeetingMaterials\/PediatricAdvisoryCommittee\/UCM191615.pdf\"><span style=\"color: #004276; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">Food and Drug Administration<\/span><\/span><\/a><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\"> (FDA) that more than 500,000 children and adolescents in America are now taking antipsychotic drugs. Of this large number, the author and experts seemed concerned that this number is growing not only among older teenagers, when <\/span><\/span><a title=\"In-depth reference and news articles about Schizophrenia - disorganized type.\" href=\"http:\/\/health.nytimes.com\/health\/guides\/disease\/schizophrenia-disorganized-type\/overview.html?inline=nyt-classifier\"><span style=\"color: #004276; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">schizophrenia<\/span><\/span><\/a><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\"> is believed to emerge, but also among tens of thousands of preschoolers. <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 12pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">The article also references a <\/span><\/span><a title=\"The Columbia study.\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20215922\"><span style=\"color: #004276; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">Columbia University study<\/span><\/span><\/a><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">, which recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. The problem this study found was that \u201conly 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.\u201d <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">From this finding, Dr. Mark Olfson, professor of clinical <\/span><\/span><a title=\"Recent and archival health news about psychiatry.\" href=\"http:\/\/topics.nytimes.com\/top\/news\/health\/diseasesconditionsandhealthtopics\/psychiatry_and_psychiatrists\/index.html?inline=nyt-classifier\"><span style=\"color: #004276; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">psychiatry<\/span><\/span><\/a><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\"> and lead researcher in the government-financed study, said that \u201cthere are too many children getting on too many of these drugs too soon.\u201d<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"font-family: Arial;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\">Consequently, while the treatment of children with such drugs remains controversial, <\/span><span style=\"color: black;\">in 2006, the F.D.A. did approve treating children as young as 5 with Risperdal if they had autistic disorder and aggressive behavior, self-injury tendencies, tantrums or severe mood swings. And two other drugs, Seroquel from <\/span><\/span><a title=\"More information about AstraZeneca PLC\" href=\"http:\/\/topics.nytimes.com\/top\/news\/business\/companies\/astrazeneca_plc\/index.html?inline=nyt-org\"><span style=\"color: #004276;\"><span style=\"font-family: Arial;\">AstraZeneca<\/span><\/span><\/a><span style=\"color: black;\"><span style=\"font-family: Arial;\"> and Abilify from <\/span><\/span><a title=\"More information about Bristol-Myers Squibb Co\" href=\"http:\/\/topics.nytimes.com\/top\/news\/business\/companies\/bristol_myers_squibb_company\/index.html?inline=nyt-org\"><span style=\"color: #004276;\"><span style=\"font-family: Arial;\">Bristol-Myers Squibb<\/span><\/span><\/a><span style=\"font-family: Arial;\"><span style=\"color: black;\">, are permitted for youths 10 or older with bipolar disorder. <\/span><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span><\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"font-family: Arial;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\">One of the major problems facing psychiatrists is the difficulty diagnosing these children. As <\/span><span style=\"color: black;\">Dr. Ben Vitiello, chief of child and adolescent treatment and preventive research at the National Institute of Mental Health acknowledged, \u201cconditions in young children are extremely difficult to diagnose properly because of their emotional variability.\u201d<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black;\"><span style=\"font-family: Arial;\">Critics of treating children with psychiatric medication blame this recent trend on physicians who \u201cencounter a marketing juggernaut that has made antipsychotics the nation\u2019s top-selling class of drugs by revenue, $14.6 billion last year, with prominent promotions aimed at treating children.\u201d<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">This assertion however is problematic because the problem is not drug marketing. It\u2019s the fact that doctors are too busy, and with re-imbursement lower for psychiatric treatment than other medical treatment, they simply do not have enough time for the adequate diagnosis of each child, especially when there are so many factors to consider in the first place as Dr. Vitiello recognized. Moreover, with the average psychiatrist having over $200,000 in debt coming out of medical school, their ability to individually treat each patient is severely restricted by their financial stability. In addition, with group practices becoming owned more and more by hospitals, there is little time for a physician to accurately diagnose a patient.<span style=\"mso-spacerun: yes;\">\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">Consequently, while the problem may get better with parity payments for psychiatric visits written into the health care reform law, it also could get worse with more patients going into the system and creating even less time to treat.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 12pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">What is needed then, as Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry recognized, is more research. Dr. Greenhill, who is \u201cconcerned about the lack of research, recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years.\u201d He acknowledged the need for this kind of research because \u201cPsychotherapy is the key to the treatment of <\/span><\/span><a title=\"More articles about pre-school.\" href=\"http:\/\/topics.nytimes.com\/top\/reference\/timestopics\/subjects\/e\/education_preschool\/index.html?inline=nyt-classifier\"><span style=\"color: #004276; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">preschool<\/span><\/span><\/a><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\"> children with severe mental disorders, and antipsychotics are adjunctive therapy \u2014 not the other way around.\u201d<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"font-family: Arial;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\">In addition to research, some states have already taken this matter into their own hands. For example, in <\/span><span style=\"color: black;\">Florida and California, doctors\u2019 concerns have led to restrictions put in place on doctors who want to prescribe antipsychotics for young children. These states require a second opinion or prior approval, especially for those on Medicaid.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">Consequently, while we are waiting to learn about the evidence-based impact of such drugs from the proposed research, and before states make it more difficult for doctors to treat children, our physicians, families and children need immediate solutions. <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black; mso-fareast-font-family: 'Times New Roman';\"><span style=\"font-family: Arial;\">What this story demonstrates is that since doctors are having difficulty making diagnoses, what they need instead of criticism or changing of state laws is more education. Similar to the success of the program <\/span><\/span><a title=\"The home page for the program.\" href=\"http:\/\/www.ecssla.org\/prog_descr.htm\"><span style=\"color: #004276;\"><span style=\"font-family: Arial;\">Early Childhood Supports and Services<\/span><\/span><\/a><span style=\"color: black;\"><span style=\"font-family: Arial;\">, children and physicians could both benefit from continuing medical education (CME) programs that focus on the diagnosis of child behavior. These programs could be designed to address particular symptoms and factors to look for in children, and examine approaches taken by a variety of psychiatrists, neurologists and other behavioral specialists. <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"line-height: normal; margin: 0in 0in 10pt;\"><span style=\"color: black;\"><span style=\"font-family: Arial;\">There is no need to waste energy or resources attacking the drug industry for doing its job, when the real work that is needed is to train and educate doctors. By educating physicians and training them with the proper methods to identify problems in children, physicians will be better suited to prescribe the right treatment, and children and their families will be healthier and happier.<\/span> <span style=\"mso-spacerun: yes;\">\u00a0<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recent story in the New York Times discussed the difficulty doctors are having diagnosing children who have behavioral problems, especially when they appear at young ages. The article focused on a young boy, who at the age of 18 months, was being seen by different doctors, being diagnosed with numerous conditions, and then being [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4770,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14,44],"tags":[1101],"class_list":["post-2690","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cme","category-media","tag-new"],"_links":{"self":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/2690","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/comments?post=2690"}],"version-history":[{"count":1,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/2690\/revisions"}],"predecessor-version":[{"id":4771,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/2690\/revisions\/4771"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/media\/4770"}],"wp:attachment":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/media?parent=2690"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/categories?post=2690"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/tags?post=2690"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}