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Pills 'R' Us

[whitespace] Local population of schoolchildren reflects ample use of prescription medication

By Traci Hukill

Ask a group of South Bay mental health professionals about psychoactive drugs, and the responses are likely to be as subtly varied as the prescriptions in any school nurse's office--Ritalin, Dexedrine, Cylert, Prozac, Zoloft, Paxil. The opinions run like this: They're overrated; they're highly beneficial; they're prescribed too casually; they're misunderstood; their use is rampant within one class of kids and too scarce within another.

But local psychiatrists and psychologists manage to agree on two essential points about medicating attention deficit disorder, attention deficit/hyperactive disorder and depression: the importance of a careful diagnosis and the salubrious results of psychoactive drugs when taken appropriately.

Saul Wasserman is a child psychiatrist who has worked closely with the county mental-health system for 20 years. He chooses his words on the matter with care.

"When properly used, these drugs can be very beneficial for children," he says. "One key is whether each child receives a careful evaluation that looks at psychosocial and medical factors to make sure the drug is truly indicated." ("Psychosocial factors" is psychospeak for "problems at home.")

"Another is that the drug be supervised," Wasserman continues. "You don't prescribe medication for three months and then send the child out the door. The hazard now is with managed care, pediatricians are under intense pressure to look for quick fixes, and they will go for medication without going through a careful process."

Naturally, the fact that pediatricians and general practitioners can prescribe psychoactive drugs troubles mental health professionals, precisely because pediatricians lack the expertise to identify problems that resemble ADD or ADHD. Laura Whitmore, school psychologist at Saratoga High School, says, "A lot of times ADD is diagnosed without a lot of investigation. It's important that you look at a kid at home, in school, that you determine if it's been a problem since he was 2 years old. You have to eliminate other possible causes like anxiety, drug use and other learning disabilities. Those things could result in a lack of attention. In depression, too."

Wasserman points out that South Bay parents are a little leery of putting their kids on drugs. "The public that comes into my office is cautious about medicating, and they are relieved when I do a reasonable evaluation," he notes. "Parents in general are not quick to throw medicine at people's problems."

That depends on which parents, says Andrew Giammona. A child psychiatrist with Eastfield Ming Quong, a nonprofit mental health agency that works closely with local schools to serve mentally disturbed children, Giammona sees some parents who are overeager to get their kids on meds, while others remain oblivious to the severity of their children's problems.

More troubling than parental pressure to medicate, though, is pressure to do so from the schools. "There's been a big push in schools to medicate," Giammano observes. "Teachers and principals see it as a panacea for difficult kids. To me questions arise when they say, 'We won't take this kid back if he's not medicated.'

"I understand their frustration," he says. "You have a class of 30 kids and this child is disruptive, but if you're saying things like that--who's deciding that? What's your training, your background?"

Giammano resists pressure from the schools when he thinks medicating is inappropriate. Asked if he encounters resistance to his diagnoses, he laughs.

"Sure I do. And I tell 'em to call me."

David Arredondo, medical director at Eastfield Ming Quong, identifies the fault between over- and underdiagnosed kids as one that falls along class lines.

"If you go to Juvenile Hall," he points out, "there are kids with psychiatric illnesses who are not being treated. The way poor kids get treated is in Juvenile Hall rather than the mental health system."

Like others in his field, Arredondo sees too many misdiagnoses for comfort. "They'll call the kid ADHD, but really the child's depressed," he says. Then he cuts to the heart of the matter.

"The real problem is kids don't value themselves because no one values them. It's a symptom of a society that doesn't have time for its own children. It's a deeper social malaise."

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From the April 30-May 6, 1998 issue of Metro.

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