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CNN Today

Dr. Coyle: 'We Have a Problem With the Provision of Psychiatric Services to Children'

Aired February 23, 2000 - 1:33 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

NATALIE ALLEN, CNN ANCHOR: Psychiatrists today are troubled by a report that more preschoolers are being given drugs to curb their behavior. Today's "Journal of the American Medical Association" says from 1991 and 1995 overall psychiatric drug use increased 50 percent in two- to four-year-olds. Stimulant use tripled. After stimulants, antidepressants are now the second-most commonly prescribed psychiatric drug in that age group.

The report means thousands of American preschoolers are taking these drugs during a key period of their brain development, and the effect is so far unknown.

Those are among the concerns expressed by our guest, Dr. Joseph Coyle. He's the chair of psychiatry at Harvard Medical School.

And thank you for joining us to talk about this.

The chairman of the National Institutes of Mental Health called these finding beyond shocking. What's your reaction to the study?

DR. JOSEPH COYLE, CHAIR OF PSYCHIATRY, HARVARD MEDICAL SCHOOL: I was very troubled when I read this report, because severe behavioral disturbances of children of this age are generally managed through psychological interventions and drugs would be used extremely rarely. So the fact that almost one-and-a-half-percent of children ages two to four were receiving these drugs really suggests that we have a problem with the provision of psychiatric services to children.

ALLEN: And so how is this happening? Can any parent whose child becomes a problem at school get this drug via a doctor for their child?

COYLE: Yes, you don't have to be an expert in child psychology to prescribe any of these medications, and in some situations even nurse practitioners may prescribe these drugs. I think that if a child is reported having severe behavioral problems in this age group, I would suggest that the parent take them to someone with expertise and child psychiatry before starting him on these medications.

ALLEN: How can parents know what to do in these types of situations? Are parent kind of in the dark here?

COYLE: Well, typically, a parent would take the child to their primary care physician at their HMO, for example. If after a very cursory evaluation prescription drug, prescription for a psychotropic medication is recommended, I think it's then when a parent should ask for a consultation with an expert in the field, like a child psychiatrist.

ALLEN: And what do we know, doctor, about the long-term effects of these drugs on such very small children as far as their brain development goes, because this is a crucial time for them, is that correct?

COYLE: Oh, absolutely. There -- there is very little information on the -- on the impact of these drugs on children. There -- it is clear that this is a period of very rapid maturation of the brain, and in experimental animals we have evidence that the chemical messengers that these drugs affect are very important in shaping brain development.

ALLEN: Some experts are speculating on how this is happening. Here are three examples: that HMOs and subsidized medical care programs are reluctant to pay for behavior and therapy, that there are pressures on parents and schools to make a diagnosis and the rise of drugs as the preferred mode of treatment. Would you agree with those? Do you think that society is becoming more apt to use drugs as a quick fix, even for very small children?

COYLE: Well, as I concluded in my editorial, that was my concern, that these drugs are being used as a quick, inexpensive fix. I think it's important to recognize that while teachers may identify problem behaviors in children because of the time they spend with them, they're not expert in diagnosis or making treatment recommendations. And again, in many HMOs there's a deterrent for referring patients, and that includes children, to specialists for evaluation and to try to treat these conditions simply with drugs.

ALLEN: Well, Dr. Joseph Coyle from Harvard, we thank you for joining us today.

COYLE: Thank you very much.

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