Are children being over-medicated for mental health issues? We spoke to DR ADRIAN LOH, Senior Consultant Psychiatrist at Promises Healthcare, who explained how doctors balance the use of drugs like or ODC or ADHD medication for kids with a duty of care in diagnostics and treatment.
Dr Loh’s general observation around healthcare in Singapore is that both parents and doctors remain cautious in the use of medication in children and adolescents being treated for mental health issues.
Yet, while it’s appropriate to exercise due diligence before starting medication – especially in view of possible side effects – there is a flip side when they’re withheld without good reason.
“This may be due to insufficient understanding of the medication,” says Dr Loh. “There may be unfounded fear of ‘addiction’ or concerns about costs of treatment, for example, or it could be because of the persistent underlying social and cultural stigma around mental illness.”
What to take into account when considering medication
The decision to use medication, he says, should be a carefully considered one, taking into account a few key areas.
In making a diagnosis, a good practitioner should also identify relevant factors that influence a child’s mental health condition, including their age and education level, the presence of other medical conditions, underlying temperament and personality traits, family and interpersonal relationships, as well as socio-cultural norms.
There should be an assessment of the severity of the child’s symptoms and the level of distress caused to the child – and in some cases, to those around him.
The practitioner should be able to confidently assess the impact of the condition across different areas of the child’s life.
For parents, stress around children’s mental health can be significant. For many of us, the tendency is to observe a child for signs of mental distress, but then wait to act. When we finally cannot intervene to help anymore as the child becomes a teen and even more inaccessible, we then realise it’s time to get professional help from therapists and psychiatrists.
From there, it can be an extended journey, according to Dr Loh. A patient may need months of therapy to unpack and get to the root of their fears, mood swings or erratic behaviour. Depending on the considerations mentioned earlier, the doctor will consider the use of medication to try to alleviate some of their symptoms at a suitable juncture.
“For example, a child could be diagnosed with mild ADHD (Attention Deficit Hyperactivity Disorder), but if there is a significant impact on their friendships or their ability to cope with schoolwork, and if other attempts at helping, such as classroom management, have been unsuccessful, it may be timely to introduce the use of ADHD medication for kids.”
Patient and parent responses
Dr Loh also notes that not all medication is going to “work” the way we want it to. Every patient responds to therapeutic drugs in a different way. “Some drugs that are used to treat mental health conditions may not have the intended effect and the doctor may then have to cycle through several different types to land on the right one. This can be distressing for the patient as well as parents, who can feel that the child is ‘over-medicated’.”
It’s a conundrum that requires patience from all involved, as not trying medication altogether may cause more harm, he says.
“Another illustrative case is with OCD (Obsessive-Compulsive Disorder). This is a condition that local and international studies have shown to be often characterised by a prolonged duration of untreated illness, extending even past a decade for some individuals. In many of the young people I’ve treated, my personal experience is that it would have been beneficial for them to have been started on medication much earlier in the course of their illness.”
At the same time, there are some instances where antidepressants may not be the most helpful solution. “Inappropriate use of medication is another valid concern,” says Dr Loh. “One example would be to ignore the underlying factors contributing to a child’s depressive symptoms. These could include unresolved grief after a death in the family, or feelings of helplessness or guilt about parents’ marital conflicts. In these situations, it’s wise not to offer antidepressants as a cure-all. Instead, offer counselling or other forms of therapies alongside the judicious use of medication to help the child in a holistic manner.”
In instances where parents describe “over-medication”, Dr Loh says that it could be possible that some children may have been offered medication without considering other alternatives. “When experiences of this kind are shared with other parents, it can lead to a perception that medication is overused.” He adds that if medication at a particular dose has been tried for a certain period and doesn’t result in an improvement of symptoms, this too can lead to an unwarranted generalisation that medication is ineffective.
It’s about taking the time to come to the right solution – because making or sticking to an inaccurate diagnosis can lead to the inappropriate use of medication. “If a teenager has symptoms of what we call hypomania (a less dramatic state of elevated mood) and those symptoms are missed and they are treated only with antidepressants, it can lead to a poor treatment response or even a worsening of what eventually can turn out to be a bipolar disorder.”
Mental health hangs in a delicate balance for both children and adults. It needs much more attention than we tend to give it, says Dr Loh – it’s all too easy to ignore the symptoms of unease and distress and block them with screen distractions. If you have concerns, he suggests speaking to a therapist as a key part of your self-care regimen.
About the doctor
Dr Loh is an experienced psychiatrist with a subspecialty focus in child and adolescent Psychiatry. He has a special interest in Obsessive-Compulsive Disorder and anxiety disorders, expertise in military and aviation psychiatry and a strong appreciation for the cross-cultural aspects of mental wellbeing.
This article was first published on the Expat Living Website on 30th March 2023 and written by Anna Murphy.