Substance Abuse and Child Mental Health: Are We Contributing to a Problem We are Trying to Solve?
There has been a recent dramatic broadening of diagnostic criteria accompanied by an increase in prescription rates of psychoactive medications despite limited understanding of the long-term effects on the developing brain. Untreated mental illness is harmful to brain development and diagnosis and treatment can be beneficial, but an inappropriate diagnostic label and pharmacological intervention instead of teaching children self-regulation, coping skills and accountability for behaviors can have lasting consequences.
A comprehensive psychiatric evaluation can help to determine whether an emotional or behavioral problem is psychiatric in nature, related to a medical condition or possibly a response to something environmentally provoked.
An accurate diagnosis can be validating and lead to much needed, sometimes lifesaving treatment. Efforts to reduce the stigma associated with mental illness has empowered may individuals to seek help rather than suffer in silence. Depression and anxiety in children, once widely disregarded, is being recognized and treated earlier and preventing a progression that could otherwise become crippling.
Consider, however, the concept of over-diagnosis and how that could fuel the current substance abuse crisis. I will first reinforce that not all mental health diagnoses in children and youth are inaccurate and untreated mental illness can have devastating consequences. My focus here is on the potential for overdiagnosis and over-treatment (more specifically over-medication) to fuel a latent killer.
Behaviors and fluctuations in mood that were once considered to be within the range of normal development have now become diagnostic criteria sufficient to label an abnormal condition. All diagnoses, beneficial or not, changes the child’s perception of self and caregiver and society’s perception of the child. Risk factors have become diseases themselves with diagnostic labels and while assigning a diagnosis to a presenting complaint can validate a patient’s perception of symptoms, it can also pathologize normal fluctuations in mood. Overmedicalization and overdiagnosis of traits and risk factors as psychiatric conditions contributes to patients being disproportionately dependent on services. This trend contradicts patient autonomy and disempowers individuals to contribute to preventive measures. Unhappiness and grief become depression; shyness becomes anxiety; inattention and restlessness becomes ADHD. Management consists of a disease label, prescription medication and/or referral even with little evidence of long-term benefit. Even without risk factors expanding into conditions, variations in normal development become diagnostic traits. The youngest children for a given grade level are more likely to be diagnosed with ADHD, suggesting not only overdiagnosis, but misdiagnosis and labeling immaturity as ADHD.4
It is imperative that we all contemplate the decisions we make on behalf of our children. Preventing substance use disorders must involve a multifaceted approach to risk mitigation to include increasing awareness and addressing some of the more subtle contributions to a thriving epidemic.
Are we teaching them that uncomfortable emotions are unacceptable and must be eliminated by taking a medication? Are we teaching them that they cannot control their behavior without taking a medication. Are they learning that problematic tendencies indicate a medication change rather than a behavior change? Are we allowing them to develop coping and self-regulation skills? Are we giving them the opportunity to take responsibility and hold themselves accountable for their responses to life and inevitable stress?
Individuals rapt in the throes of addiction tend to have poor stress and frustration tolerance, seek instant gratification in eliminating discomfort and often shift the blame for their impulsive behaviors onto someone or something else. Have we created a culture that almost nurtures the evolution of such traits in childhood?
I look forward to presenting some surprising and disturbing trends in prescription medication abuse beyond pain killers and sedatives in my next post.
 Mitchell, P.B. (2012). Bipolar disorder: the shift to overdiagnosis. Canadian Journal of Psychiatry, 57(11), 659-665.
 Merten, E.C., Cwik, J.C., Margraf, J., Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and Adolescent Psychiatry and mental Health, 11, 5.
 Hendriksen, E. (2016). Should kids take psychiatric medication? Retrieved from https://www.scientificamerican.com/article/should-kids-take-psychiatric-medication/.
 Coon, E.R., Quinonez, R.A., Moyer, V.A., Schroeder, A.R. (2014). Overdiagnosis: How our compulsion for diagnosis may be harming our children. Pediatrics, 134(5), 1013-1023.
 Vilhelmsson, A. (2014). The devil in the details: Public health and depression. Frontiers in Public Health, 2, 192.
 Rumalean, Y. (2017). The three-step approach for mental health and beyond. Frontiers in Public Health, 5, 85.
 Doust, J., Glasziou, P. (2013). Is the problem that everything is a diagnosis? Australian Family Physician, 42(12), 856-859.