PBS Frontline: The Medicated Child

[Guest guest]

PBS Frontline: 'The Medicated Child'

Transcript | Frontline producer Marcela Gaviria discusses her film

" The Medicated Child, " which examines the dramatic increase in the

number of children being diagnosed with serious psychiatric disorders

and prescribed medications that are just beginning to be tested in

children -- and which could cause serious, long-term side effects.

Wednesday, January 9, 2008; 11:00 AM

Frontline producer Marcela Gaviria was online Wednesday, Jan. 9 at 11

a.m. ET to discuss her film " The Medicated Child, " which examines the

dramatic increase in the number of children being diagnosed with

serious psychiatric disorders and prescribed medications that are just

beginning to be tested in children -- and which could cause serious,

long-term side effects.

" The Medicated Child " airs Tuesday, Jan. 8, at 9 p.m. ET on PBS (check

local listings).

The transcript follows.

Gaviria won the 2005 Emmy for her documentary " The Storm, " the

prestigious 2003 duPont Columbia Silver Baton for " Truth, War, and

Consequences, " the 2002 duPont-Columbia Gold Baton for her post-Sept.

11 films " Looking for Answers " and " Saudi Time Bomb? " and an Emmy and

a Peabody Award for the four-hour series " Drug Wars. "

Gaviria's work for " Frontline " has taken her to Iraq, Pakistan, Yemen,

the Palestinian Territories, the United Arab Emirates, Oman, Kuwait

and Korea. Most recently she made her sixth trip to Baghdad for " Gangs

of Iraq. "

____________________

Chicago: What was the name of the song at the end?

Marcela Gaviria: That's " Just Like You " by Hannah Montana.

_______________________

Washington: This is a very engrossing and interesting program, but the

lack of critical mention of anti-psychiatry icons, and the inclusion

of critical views on psychiatrists, was a little disconcerting. Also

disconcerting was the fact that " Frontline's " previous forays into

controversy in psychiatry were funded by EarthLink, a company founded

by a Scientologist and staffed in management with Scientologists. This

is as if Pfizer funded the show, but it is a lot less transparent, and

the lack of transparency and full disclosure is what bothers me. Were

you aware of this company's sponsorship of previous " Frontline "

editions on such a controversial subject?

Marcela Gaviria: Frontline currently is funded the MacArthur

Foundation. We are absolutely independent. If you want to read our

journalistic guidelines, feel free to do so. They are on the Web. As

for the previous show, you will note we were highly critical of the

Scientology movement. For more, please see the web site for the show.

_______________________

Hawthorne, N.Y.: I watched last night and was amazed at how young and

how many children in our country are medicated on so many pills. The

show was a wake-up call to me as a parent, as I have a child who was

diagnosed with ADHD at age 10 and currently is taking Strattera. I

felt the pain of those parents. My question is, what is the cause of

these mental illnesses; why are so so many cases now being diagnosed

younger and younger? I don't recall anyone I knew being on medication

when I was a child.

Marcela Gaviria: This is a great question and a hard one to answer.

There are many theories. One is that there is " genetic loading, "

meaning kids are getting symptoms younger and younger. Doctors now

believe that environmental factors are probably part of the equations

as well -- toxins in the environment, demands on kids putting more

stress, global warming, etc. As with so much in this field, it's a

question that needs more research.

_______________________

Washington: Hi. I really enjoyed the program last night, even though I

found it disturbing. Why do you think this generation of children

seems to have so many emotional problems?

Marcela Gaviria: Thanks for watching. I think the question above

addresses this.

_______________________

Freising, Germany: If there might be links between bipolar disorder

and novelty seeking, and there also might be a genetic susceptibility

to depression and bipolar disorder, then it sounds like these mental

illnesses are part of the nature/nurture debate. But if the

environment plays an important role in the development and diagnosis

of such ailments, when adolescent or adult patients start receiving

medication for depression or bipolar disorder, how often does it occur

that they must take the medication for the rest of their lives? Do

patients develop a physical dependence on medication, even if a change

in environment might help to alleviate symptoms?

Marcela Gaviria: Classic bipolar is a life long condition and usually

medication is a big part of treatment. With kids, it's a trickier

question because so much isn't yet known about how the kids who are

showing symptoms very young will develop over time. I think doctors

would say we really need more time to watch these kids develop with

time. I don't think the medications used for bipolar (mood

stabilizers, etc.) cause dependence, but that's a good question for a

doctor.

_______________________

Brookline, Mass.: I missed the program but would like to know if any

mention was made of children -- particularly minority children --

being misdiagnosed with ADHD or bipolar disorder?

Marcela Gaviria: We weren't able to deal with the question of minority

children in particular, and because there aren't good epidemiological

studies it's hard to generalize on this point. It does seem that more

children in foster care are taking atypical antipsychotics than in the

rest of the population.

_______________________

Cary, N.C.: I was very disturbed while watching this show last night.

It seemed to me that the parents and doctors were too quick to turn to

chemical solutions instead of trying other options first. Do you have

an update on D.J., the 4-year-old, and how he's doing? I couldn't

believe it when the mother asked Dr. Bacon if there were other avenues

they could try (alternative therapies) and he completely shut her

down. In my opinion, these parents need to listen to their gut

feelings and find another doctor.

Marcela Gaviria: Thanks for your comment. I think this is a really

tricky situation. Doctors are in a bind -- they want to offer some

kind of help, but the way the system is set up they don't have time to

really spend time with the kids. I think that's part of what leads to

so many prescriptions. Last we heard D.J. has a lot of ups and downs,

but he's starting a new program at school that should give him more

support.

_______________________

Kearney, Neb.: Do these parents who medicate their kids show any

discipline toward their child? I didn't see one child told " no " or

receive any type of scolding. I swear these people would rather dope

up a child than deal with raising them.

Marcela Gaviria: Thanks for your comment. We spent a lot of time with

the families and we did see parents doing their best to discipline

their kids. There's actually a scene in the film where is

trying to keep D.J. calm.

_______________________

Philadelphia: I was interested in your piece, but I was concerned

about how bipolar was being grouped together with ADHD, and how the

National Institutes of Health studies on treatment of ADHD --

encouraging a multimodal treatment, with meds and behavioral therapy,

which was shown to have the best long term outcome for kids -- were

not mentioned at all. There seemed to be an anti-med bias here. I have

two kids with ADHD who are treated with meds, and I felt the piece did

not handle the issue of medicating less severe mental illness in

children very well at all.

Marcela Gaviria: When Frontline looked at the ADHD debate seven years

ago in " Medicating Kids, " this was the heart of the question. I

encourage you to take a look at that piece, because we did address the

work being done on how to treat kids with less severe symptoms. In

this piece, we chose to focus at the other end of the spectrum, where

the symptoms and medications are more extreme.

_______________________

Cleveland: Bipolar disorder is considered genetic, and so is autism.

The symptoms of many of these illnesses overlap. Is it possible that

if one group of people respond to an environmental neurotoxin (say

thimerosal) one way (showing symptoms of autism) and another group

responds another way (by showing symptoms of bipolar disorder), that

the problem is really the neurotoxin, and not the genes at all?

Marcela Gaviria: This is the kind of question that researchers in the

field are most focused on. From what we heard they believe that

environment and genes both are involved, but the answers still are coming.

_______________________

Washington: Are children in other countries having the same problems

as American children?

Marcela Gaviria: There are studies that show that incidence rates in

other countries are similar to those in the U.S., but Americans

consume far more medication than any other country in the world.

_______________________

Weston, Vt.: Do the parents depicted get counseling on parenting

skills ... including what proper nutrition, exercise and discipline

for a child? I understand that you must feel very protective of these

people after being allowed into their lives, but really, any child who

was fed what D.J. was shown eating would get sick mentally and

physically very fast. Will you do a follow-up that educates on

parenting skills?

Marcela Gaviria: Absolutely, it's crucial to look at the whole picture

and this has to come from the conversation between the family and

doctor. In this case, the Koontz family did ask about alternatives and

Dr. Bacon told them that, so long D.J. was having problems, medication

was 99 percent of the answer.

_______________________

Baltimore: After watching the program and as a parent of a 1-year-old,

I was left wondering how much a parent could do in advance of such

problems arising. In essence, I'm sure there are situations where

early intervention would have zero effect, but I'm wondering if (like

autism) there would be situations where a child who has a

pre-disposition towards a condition (like ADHD) might be able to be

prevented from developing (entirely or partially) a condition if a

parent does certain things ... like developing good conflict

management and coping mechanisms in kids, etc. Just feeling this out,

because I too was shocked about how D.J.'s parents " seemed " to ask

about nonmedicated options pretty late in the game.

Marcela Gaviria: I really don't know the answer to that. I believe

that the Koontz family, like millions of families, trust their doctor.

But unfortunately a lot rides on the parents in cases like this. There

are so many unknowns in child psychiatry, and with 15-minute

appointments it's very hard to get the really comprehensive care you

need for your kid.

_______________________

Staten Island, N.Y.: The show was well done. I am in the process of

yet another evaluation for my daughter, who is 11 years old and whose

father is diagnosed as bipolar. I was surprised at how many children

were diagnosed at such a young age. The several neurologists and

psychiatrists that we have seen feel that my daughter's age is still

too young ... I'm at a loss here ... I thought it very interesting

that Dr. Cheng (?) thinks if you catch it early, you can prevent it?

Any comments/insight for me on this issue ?

Marcela Gaviria: Dr. Chang's idea is very provocative one, but I think

he'd tell you that the key is still to identify the kids who really

will develop the disorder -- and that science is coming, but not here

yet. As for the field, there's still debate about how young is too

young to diagnose. Dr. Biederman says it's clearly in the preschool;

others won't go younger than six; and still others are deeply wary of

the whole pediatric bipolar phenomenon. It's hard to know what to

believe. Which of course, for parents, is very frustrating.

_______________________

Atlanta: Why do you think Americans medicate more than other

countries? Is it the marketing by drug companies, or the way our

health care system is set up? I also agree with the doctors not having

time -- in the past, a pediatrician had much more time for the visit,

but now it seems they are in and out in minutes, which I think is

unfortunate for everyone.

Marcela Gaviria: That's a great question and one without a single

answer, I think. Drug advertising and pressure on doctors for quick

answers both seem to be a part of it. I asked this question of

everyone and often they said that American culture is very accepting

of new ideas and that medication appeals to our faith in technology.

_______________________

Birmingham, Ala.: When the school, the psychiatrist, and the

neuropsychologist evaluate a child and they recommend medications

first, where can you find information on alternative therapies? This

child is very intelligent and achieves at grade level or better. He

seems very happy and enjoys life, but he does exhibit some elements of

ADHD and depression. Is there no other option to help him develop

successfully? What is the outcome for him if he doesn't get medicated?

Marcela Gaviria: There are other options and we heard from many

doctors that there's good evidence that in many cases -- certainly

with depression -- that the most effective treatment is a combination

of medication and another sort of talk therapy. One good source of

information on these alternative is the Web site for the National

Institute of Mental Health.

_______________________

Littleton, Colo.: You make mention that we have to see what the

outcome is on these children later in their lives from taking these

medications so young. Will you be doing any follow-up with the three

children you featured last night in the next few years?

Marcela Gaviria: I hope to continue covering this subject and would

love to keep up with these. We've thought of staying with them like

the BBC's " Seven Up! " series ... but of course, it's up to the kids to

decide if they want to continue to participate.

_______________________

Oxon Hill, Md.: Two questions ... is bipolar disorder seen more

commonly in internationally adopted children because of reactive

attachment disorders? It seems like a lot of children who were

formerly diagnosed with ADHD now are being diagnosed as bipolar?

Marcela Gaviria: I don't know the answer to the first part of your

question, but we sat in on a session at the Pittsburgh clinic and it

was startling how many of the kids admitted to the clinic were

adopted. And you're right, there is concern in the field that bipolar

has become a new " diagnosis of the day, " like ADHD before it, and that

the label is being applied a bit loosely.

_______________________

Lawrenceville, Ga.: Why is there not a third party reporting agency

for adverse drug effects, similar to vaccine reporting? Everyone I

know who has had a bad reaction has just changed medicine. Neither the

pediatrician nor the parents reported it anywhere.

Marcela Gaviria: The FDA collects reports of adverse events caused by

medications. Best thing to do would be to let your doctor know.

_______________________

Bethesda, Md.: Great program. Hopefully this isn't too personal ...

but were you or a member of your family medicated in childhood? Is

that what attracted you to this story?

Marcela Gaviria: No, I was not, but my mother is a psychologist and

I've always had an interest in the field.

_______________________

Fayetteville, N.C.: The program was a tear-jerker for me. Has anyone

ever tried hypnosis for bipolar, that you know or have heard of?

Marcela Gaviria: We didn't encounter hypnosis, but there are certainly

families that have tried everything.

_______________________

Washington: As a neuroscientist and father of two, I was appalled by

the pseudo-science being foisted upon parents. " Brain Matters " is pure

hucksterism, a 21st century form of phrenology. The cofounder claims

it's better than old diagnostic tests, even as she admits it isn't

really definitive. Well, jeez, at $3,000 a pop, it sure is a better

money-maker. What a scam.

Marcela Gaviria: Thanks for your comments. We wanted to highlight the

fact that there are so many desperate families looking for answers,

and that many are getting advice with little scientific validity.

_______________________

Littleton, Colo.: Marcela, during the show you made no mention of the

fact that the Koontz family did try many other options before trying

medication. Don't you think that it was unfair to portray them as

parents who just wanted to medicate?

Marcela Gaviria: Thanks for your comment. You'll note in the film that

we show going to the doctor to ask specifically about any

possible alternatives. She's told that medication is essentially the

only solution. I feel that that reflects her search for options and

how her story echoes the stories of millions of families who

consistently are told that medication is the way to go.

_______________________

Colorado: I think that we only saw a very small window into the lives

of these families and it is not fair to judge or comment without

knowing the whole story. We do not know what steps were taken to get

these families to where they are now. We do not know if D.J.'s diet is

like that all time. We do not know what the problems,circumstances, or

symptoms were leading up being put on eight medications and

developing tics. We also do not know what roles mental illness plays

in these children's family histories. There are so many questions that

were left unanswered -- without more information, how can we even

begin to draw conclusions?

Marcela Gaviria: That's a fair comment. It's difficult to tell all the

details of three chidren's lives and to do justice to the story of the

whole field in only 52 minutes. We easily could have made an hour on

each child. We compressed stories in the hopes of telling the larger

story of an American trend.

_______________________

Marcela Gaviria: Thanks for all your situation. And I hope you'll go

to the Frontline site and continue the discussion.

http://www.washingtonpost.com/wp-dyn/content/discussion/2008/01/04/DI20080104022\

44.html