There is a raging debate amongst mental health professionals and doctors about how appropriate it is to prescribe FDA adult-approved medication for children, and in some cases, children as young as 3 years old. There is a huge disconnect between clinicians and doctors who practice in the field, and the research evidence to support clinical decisions.

A MEDLINE research review and review of the UK’s National Institute for Health and Clinical Excellence Guidelines for Bipolar Disorder show a significant and ongoing debacle when it comes to the diagnosis of adult mental disorders in children. Worse, because there is little professional agreement on how to scientifically apply adult diagnostic criteria to children, there is even less agreement (and research) on which adult medications are effective and safe when prescribed to children.

For instance, there is FDA-approved medication for children of 3-years-old for bipolar disorder. Yet doctors are given wide latitude to prescribe “off-label” — that is, to prescribe medications to people for indications and ages which they were not approved for. Because these are “off-label” prescriptions, doctors rely on back-up often from the medical literature to help support their belief that their prescription is warranted and ethical.

But when the medical literature is all over the place, where does that leave parents who need help?

Often desperate, with doctors trying to help to resolve their child’s issues, but without sufficient data and background to help in a way that’s going to be safe and effective.

Time will tell whether the parents or the psychiatrist or both are to blame in the death of 4-year-old Rebecca Riley, but the fact is, doctors should be very, very careful in diagnosing and prescribing medications to children who are so young. There is little research support for early diagnosis of adult disorders such as bipolar disorder of children, and even less evidence to support using adult medications to treat them.

Dr. John Grohol is the CEO and founder of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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From Psych Central's World of Psychology:
The Death of Bipolar Child Rebecca Riley on 60 Minutes - World of Psychology (9/30/2007)

    Last reviewed: By John M. Grohol, Psy.D. on 9 Feb 2007
    Published on PsychCentral.com. All rights reserved.