I agree with much of what Dr. Diller describes in his article concerning the overuse of psychiatric medication in children and thank him for his kind reference to me. Too many children are receiving medication with too limited an evaluation, minimal follow-up and too narrow a focus. Too often one or more medications are being used before a careful understanding of school- and family-related issues. And we do not know the long-term consequences of these medications, especially on young children.

Where I have some trouble with Dr. Diller's approach is both his implied criticism of Dr. Biederman and relatively little focus on the current health care reimbursement system. Dr. Biederman is a leading researcher using state of the art diagnostic methods and thorough evaluation. He works with very disturbed children, many of whom would be hospitalized if those beds had not been subject to budget cuts. He and each staff child psychiatrist in his group are dedicated to and follow these patients for years and provide 24-hour coverage and availability.

However what happens nationally is not the same as in a leading research group. Because for-profit managed care has separated mental health services from the rest of medical care, many children with psychiatric needs are being seen by pediatricians, pediatric neurologists and others, all of whom, like child psychiatrists, are inadequately reimbursed. The only financially viable model of practice is a too-heavy reliance on psychopharmacology or asking families to pay out of pocket. The chief beneficiaries of the current system are the for-profit mental health companies and the pharmaceutical industry.

-- Michael Jellinek, M.D.

The rush to drugs is really an abandonment of responsibility for the welfare of our children. Many of these problems are related to divorce and poor family dynamics. Hyperactive and acting-out behaviors are normal responses to some kinds of social situations; the potentials may be genetically encoded, but they're brought out by social contexts.

The desire to resolve apparently aberrant or disruptive behavioral patterns with drugs reveals not only a scientific/biological commitment to emotions and behavior in our society, but also its individualist underpinnings. Drugs are the individual solution; unfortunately, individual solutions to social problems won't work.

-- John A. Guidry

In this day and age blaming a person's genes is simply one more way of saying "I haven't a clue what the cause of the problem is." Psychiatrists drug our kids because it's a lot easier than handling incompetent parents, teachers or schools. It's a whole lot easier than complex testing to see what kind of diet change might help or working with your kid to help him understand the subject he's having trouble with at school.

I have no doubt that the pharmaceutical industry will generate lots of studies that show that these drugs work for kids. After all, if there's profit to be made, do it.

When are we ever going to learn that raising kids isn't easy, and that a pill is not a substitute for loving care and guidance?

-- Robert C. Johnson

While I agree that far too many children are being medicated to make them more compliant, we finally took a hard look at whether Adderall would be appropriate for our 11-year-old. With the help of an experienced counselor and a pediatrician specializing in ADD, it finally made sense to us. The medication has helped a lot, but I think what gets overlooked is how important it is to have much, much more than meds. As a society, we need to take a hard look at our priorities. Unfortunately, too many adults like the quick-and-easy solution of a little pill. That's not what kids need. They need a community of sober adults.

-- Deborah Fisher

Next page | Hidebound, moribund, inward-looking and, most of all, unreadable