Clinical psychologist Gretchen Watson said the rapid rise in childhood ADHD diagnoses helped normalize the prescribing of multiple psychiatric medications to young children, including stimulants, antidepressants, mood stabilizers and antipsychotics.
By yourNEWS Media Newsroom
A clinical psychologist and researcher is warning that attention-deficit/hyperactivity disorder became an entry point for the widespread psychiatric drugging of American children, with millions of young people now taking medication for the condition and many receiving more than one psychotropic drug.
Roughly 10 million U.S. children and young adults ages 2 to 24 are taking medication for attention-deficit/hyperactivity disorder, and 40% of them are taking multiple psychotropic drugs, including antipsychotics, according to Gretchen Watson, Ph.D., a clinical psychologist and researcher who has studied the overmedication of children with psychiatric drugs.
“That is just absolutely unconscionable,” Watson said. “It makes no sense. The children aren’t the problem. We are.”
Watson, described on her website as one of the country’s foremost authorities on the overmedication of children with psychiatric drugs, spoke May 4 at the MAHA Institute’s Mental Health and Overmedicalization Summit in Washington, D.C. Her remarks focused on the surge in childhood ADHD diagnoses in the late 1990s and the prescribing patterns that followed.
“It’s now evident with the benefit of hindsight that ADHD is a gateway diagnosis that opened the door to the medicalization of childhood and to drug cocktails for young children,” she told the audience.
In a May 26 exclusive interview with The Defender, Watson discussed material from her forthcoming book, “Prescription Affliction,” which she described as “a road map for parents, educators, and clinicians who want to protect children and find better paths forward.”
Watson said her concerns developed during the 1990s and 2000s while she was studying ADHD diagnoses and psychiatric prescribing trends. She first worked as a psychologist in a pediatrics department in San Diego, where she said relatively few children were diagnosed with ADHD.
Her experience changed after she moved to Hampton Roads, Virginia, for what she expected would be similar work.
“I was supposed to be doing exactly the same work, but the pediatricians were diagnosing most of the children with ADHD,” Watson recalled.
She said the rate of diagnosis in the clinic immediately raised concerns.
“Why are we doing this?… We’ve diagnosed 75% of the children who’ve come into our clinic with ADHD. This doesn’t make sense,” she said.
Watson later examined student data from local schools to determine whether the pattern extended beyond her workplace. By 1999, she found that nearly 1 in 5 children in Hampton Roads had been diagnosed with ADHD. Half of the diagnoses were made before first grade.
Among children diagnosed with ADHD, 84% were receiving medication. Of those medicated children, 28% were taking two, three or four psychiatric drugs.
“That meant we were diagnosing more ADHD than any place else in the country and we were medicating it aggressively,” she said.
Watson said she repeatedly reviewed the data to make sure the findings were accurate. She was later asked by staff at the U.S. Drug Enforcement Administration to independently evaluate a large national database tracking Ritalin distribution rates.
“I was able to look at what was going on in the country and see that, in fact, my data really were on target because we were in the top 1% for Ritalin consumption for the country,” Watson said.
Watson said she initially explored whether the large military population in Hampton Roads helped explain the high diagnosis and prescription rates. After comparing military and non-military children, she said the difference did not account for the trend.
She later learned that pediatric neurologists at the local children’s hospital had created a clinical research organization conducting drug trials. The work began with ADHD drugs, she said, then expanded.
“But it was so lucrative that they rapidly expanded,” Watson said.
Watson said she believed the neurologists involved in the trials likely had good intentions, but warned that pharmaceutical relationships can affect prescribing habits.
Research has shown “it takes very little contact with a pharmaceutical rep to have a prescriber’s behavior influenced,” Watson said. “So if you’re interacting extensively and getting large payments for testing their drugs, you’re going to also prescribe their drugs.”
Watson said the influence began with specialists and then spread through the broader medical community.
“It really started at the children’s hospital with the ‘experts’ who had been trained. And then what happens is the community doctors want to mirror the experts. So it becomes a thing, and then parents don’t want their child left behind.
“When the parent says, ‘Well, Sarah has been getting straight A’s, she comes right home and does her homework if I give her Ritalin.’ Well, the next parent who hears them thinks, ‘Well, maybe my child should get the medication too.’”
Watson said the acceptance of stimulant prescriptions for ADHD helped make additional psychiatric drugs for children appear routine. She said long-term stimulant use can produce significant side effects, including mood changes, mania and depression. Those effects can then lead doctors to prescribe still more drugs, she said.
“Antidepressants get added, mood stabilizers get added. Now you’ve got children’s moods and minds being affected in a variety of ways. And before you know it, antipsychotics are added to the mix,” she said.
Watson said the Hampton Roads findings should have alerted the country to a larger problem with ADHD medication. Instead, she said, the prescribing trend spread nationally and now includes toddlers placed on ADHD medications, usually stimulants.
Watson said the long-term data on ADHD medications do not support the broad assurances often associated with the drugs. She cited links between higher school prescription rates and higher rates of prescription stimulant misuse among teens, as well as worse educational outcomes among children medicated for ADHD compared with children diagnosed with ADHD who were not medicated.
Watson said she initially doubted that ADHD medication could be tied to poorer educational outcomes when she saw the pattern in her Hampton Roads data.
“Gosh, that can’t be right,” she recalled thinking.
She said the 1999 Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study, funded by the National Institute of Mental Health, later confirmed the concern. The study evaluated behavior therapy, medication and combined treatment for ADHD.
Watson said children on medication appeared to perform slightly better in the short term, but the longer-term results told a different story.
“The longer the children were on the medication, the worse their social, emotional and academic functioning became,” Watson said.
“But those long-term results were never trumpeted in the media, while the short-term effects were,” she said. “And to this day on the NIMH website, it lists only the outcome of the short-term — the first pass of the data — and it still pitches the medication as safe and effective. That’s a misnomer.”
Watson said the overprescribing of psychotropic drugs to children remains a serious problem, but one that can be changed. She encouraged parents to learn how many children in their own communities are diagnosed with ADHD and how many are placed on medication.
“People need access to what’s going on in their community so they can take action at the community level,” she said.
Watson said her forthcoming book gives parents guidance on resisting pressure to accept an ADHD prescription too quickly or unnecessarily.
“I talk about the importance of really seeing your child for who they are. That sounds simple, but I go through some strategies of how we get back to really having a presence where we can more realistically see our children without panic.”
She said cultural expectations for children also need to change.
“We’re intolerant, we’re afraid and our kids are indoors and on devices way too much,” Watson said.
Watson said physicians should consider non-drug approaches first and should provide full informed consent before prescribing psychiatric medication to a child. She also said social workers, psychologists and family counselors must reconsider their role in reinforcing the prescribing culture.
“They are part of the problem because they have bought into the mindset, too, that we are suffering from these chemical imbalances and they play a role in referring people to doctors and reinforcing what doctors are doing.”
Watson also warned against turning children’s mental health into a partisan issue.
“This has nothing to do with politics left, right or center. This is strictly evidence-based and affects people of every persuasion.”
She said the country has an opportunity to make national changes if the issue does not become consumed by partisan disputes. Referring to U.S. Health Secretary Robert F. Kennedy Jr., Watson said the moment is unusual because Kennedy has a history in one party while serving in another administration.
“We are really at a historic moment when we have somebody who is historically a Democrat working in a Republican administration to move these issues front and center.
“So I hope that people don’t get distracted by partisan politics when it comes to improving child mental health.”
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