How to Help Your Kid Avoid Bad Mental Healthcare
Much treatment is outside accepted medical guidelines
If you live with any of the 17% of American children with common mental health disorders, then you know that managing them is like parenting while simultaneously battling destructive ghosts. Now a duo of alarming studies out of Princeton University finds that the majority of these kids receive bad care. “Quite a few are receiving treatment that’s inconsistent with existing guidelines,” says lead author, Emily Cuddy, a doctoral candidate in economics at Princeton University, who recently spent a year wading through insurance claims data for 2.2 million children.
The last thing you need is a troubled child receiving sub-par care. Let me help you: The good news is that both studies conveniently lay out precisely how to avoid this fate.
First, let’s spell out your role here. Your job is to access professional consultations as needed, and when warranted, treatments that meet medical guidelines. Simple enough. You can handle this.
Most parents do not do the latter. Cuddy’s first study, published in the Proceedings of the National Academy of Sciences, followed 200,000 children’s first mental health visits (ages 10 to 17). The findings are appalling: American children receive widely varying treatments for the same conditions, many of which diverge from standard guidelines, such as the almost-quarter of children prescribed drugs but not therapy.
Just under half of those drug prescriptions are for medications not recommended for children as a first treatment, such as benzodiazepines, and the study tracked only children insured by Blue Cross Blue Shield, who theoretically have access to good care.
“The scariest thing is that so many kids are receiving these drugs that are inconsistent with guidelines, that aren’t even FDA-approved, which in some cases physicians groups actively say you shouldn’t be putting kids on — particularly for their first treatments. It’s surprising,” Cuddy says.
But! Her second study, a National Bureau of Economic Research working paper, followed 97,000 teens for the two years following their first appointment, and found that much drama can be avoided with standard care. The children treated with inappropriate drugs suffer more hospitalizations, more ER visits, and nearly double the medical costs.
When doctors prescribe appropriate medications, “then you actually see improvements among the kids, relative to kids who had only therapy or who had no treatment,” says co-author Janet Currie, an economics professor at Princeton.
So your work here is to make sure that your child’s practitioner is following treatment guidelines. Start by Googling “guidelines for evidence-based treatment of childhood [name of disorder].” Helpfully, they’re rather consistent. Generally, behavioral therapy is the first step.
“Anxiety, for example, is super workable and treatable behaviorally,” says Bobbi Wegner, supervising clinical psychologist at Boston Behavioral Medicine, who is also a lecturer in human development in psychology at the Harvard Graduate School of Education. “A lot can be done working with thoughts, emotions and behaviors. Kids’ brains are still developing, so medication is really a last line of defense.”
She says to seek consultation when you see changes in thoughts, emotions or behavior. “If any of those categories change sort of wildly, and then persist, say to yourself, ‘OK, what’s going on here?’” These big feelings might present as meltdowns that implode your days, or more subtly, as shifts in sleep, appetite or energy, like a sporty kid who hasn’t picked up a ball in weeks
Life changes such as divorce are also a good reason to check in with a specialist. “Just because a child isn’t showing symptoms doesn’t mean she’s not actually going through something. She may be a perfectionist-type child who internalizes it.”
The stakes could not be higher. If you’ve ever hid under the covers with depression or anxiety, you know that a childhood in that mental space easily reroutes a life path. Currie, a research force of nature with over two dozen published articles in 2020, previously found that common psychological disorders have much more severe effects on children’s trajectories than physical ailments. Translation: You need to handle this pronto.
Medication should not be added to a therapy regimen unless the child would be abetted by one of the few things that child psychotropic medications do well, says clinical psychologist Ross Greene, the well-known author of “The Explosive Child.”
“The list isn’t long,” Greene says. “Medication can reduce hyperactivity well, and can improve impulsiveness and attention span. It can reduce anxiety and enhance mood, though not as reliably. And it can give kids an emotional muffler if they’re overreacting to everything — a longer fuse, though also not as reliably.” That’s it, he adds. That’s the whole list.
Greene is less inclined to prescribe when a symptom is well tolerated by parents, children and teachers. For example, an extremely hyperactive child who is doing well in 2nd grade might not warrant medication. That might change when all hell breaks loose in 3rd grade. Greene says he commonly sees families for one-appointment consultations. “Some people don’t need me very much.”
Currie suggests jotting down three questions for practitioners: Is this treatment or drug the typical therapy for children in this stage of treatment? If not, why are you recommending this treatment? Is this drug FDA-approved for use in children?
“People are afraid to ask questions, and that can be a problem,” says Currie. “A lot of medications haven’t really been well-evaluated in children.”
This all spotlights a baffling occurrence: Why on Earth are doctors frequently prescribing non-standard psychotropic drugs to children? Currie doubts that the pharmaceutical industry is to blame. “Most of these drugs are generics. Other studies have observed that a lot of doctors kind of have their favorite drug for a particular condition, and then they just prescribe that drug to everybody who comes through the door.”
Doctors might only have one pediatric patient with a particular disorder, and simply not know; region also matters, with striking geographic differences in favored drugs.
You will, by the way, face the same scenario in your own medical care. Yet another of Currie’s 2020 studies found that the drugs prescribed for adult depression vary widely. You want a doctor who prescribes from a broad portfolio of medications and, you know, actually follows treatment guidelines.
Next up, Currie and Cuddy are unpacking what drives these quirky prescribing habits. Inexperience? Misinformation? Google them next year to find out how to choose a doctor. In the meantime, your best bet is standard care.