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Mental Health of US Children

Best-selling author and journalist Judith Warner met with NIMH Director, Tom Insel . Warner has written extensively about American family culture, raising children in today's society, and now, the challenges faced by families of children diagnosed with mental disorders. Ms. Warner is a former contributing columnist for the New York Times and was a special correspondent for Newsweek in Paris.

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Announcer: Best-selling author Judith Warner was the recent guest of National Institute of Mental Health Director Tom Insel on the Bethesda campus. The conversation began with research for a book Warner wanted to write on, what she called at the time, the culture of children over-diagnosed and over-medicated for mental disorders.

Judith Warner: I saw behavior of parents around me which seemed very, very strange. I was seeing children being sent for all kinds of odd therapies I’d never heard of before. I was seeing kids get diagnosis  I had never heard of before. I was hearing about older children- mine were  at the time- my oldest was in pre-school- being on medication. And this was just mindboggling to me… I had never heard about  this kind of thing before. And I really thought that it had to have something to do with these kind of anxious, competitive times that we live in.

Announcer: But then, Warner began research for the book including numerous interviews with doctors. As she wrote in a March 2010 opinion piece for CNN.com, “…soon, the facts got in the way. Surveys and statistics showed that the story of over-diagnosis and over-medication was wrong.”

Dr. Tom Insel: At the end of the day, where did the data take you… where did the story take you?

Judith Warner: The story took me to understanding that you have five to twenty percent of kids in America, according to government statistics, who are believed  to have mental health issues. And you have five percent of kids overall who are taking medication. So, that it doesn’t add up to a big picture of over-diagnosis and over-medication. That when you look at studies over the decades that have looked at the way medication are being used…. you find inconsistencies- you find pockets maybe of over medication in certain regions but you don’t find a big, overall picture.

Dr. Tom Insel: What would you say to someone who says, you know, when I was growing up, we didn’t have all these kids with all these diagnosis and all this medication. Do you think things have actually changed or do you think at that point we still have the problem that…. we didn’t deal with it.

Judith Warner: I would say at that point we didn’t see those children. That we didn’t, by and large recognize them. And that they were a lot less visible too. Because children with serious mental health issues were institutionalized in much greater numbers and for a much longer time than they are now. That you had in the ‘60s children who were going away for a matter of years sometimes. Through the ‘80s you had children who were still being sent away – put in institutions for periods of months. That when children were taking medication- which they were- but there were so many fewer medications… they were taking something like Thorazine- that was happening in a hospital setting.  They weren’t at home taking medications and so you weren’t aware of it… you didn’t see them.

Announcer: With her latest book completed, Warner anticipated mixed reviews.

Dr. Tom Insel: And you’ve got quite a different story to tell. How’s that been received as you’ve talked about it?

Judith Warner: Well, as you might imagine, it’s been very well received by physicians… by psychiatrists in particular… by pediatricians as well. There has been very positive response from parents of kids with mental health issues. Very, very positive. People feeling like someone is finally understanding what they’re going through and sympathetic to what they’re going through. The book recently was awarded the outstanding media award this year by the National Alliance on Mental Illness. That’s been wonderful… very, very validating.

Dr. Tom Insel: Where are the things - where are the places where you think we need more research… where we should be investing more to get more information for the public?

Judith Warner: I think we desperately need more and better research into medications- their long term effects… their side effects… their safety. Parents are really scared and with good reason because we know that the research that we have… so much comes… the majority of it – vast majority- is done by the pharmaceutical industry. And there really is such a sense of eroded trust… again, I think for good reason. And so, parents are having to take a leap of faith basically when they agree to use medication for their children. They’re having to take a leap of faith to think that their doctor does have access to very high quality research. And there is some very high quality research that exists that’s been done here.

Announcer: Warner says she has come away with an even better understanding of the sensitivities and challenges faced by these families.

Judith Warner: I think that its hard getting the message out… it’s hard to get the message out to the people who very strongly believe the opposite point of view. It’s a little bit hard getting the message out to people who don’t have children with mental health issues because they feel unconcerned by it. There are even, I have been told, and it’s interesting, people who won’t come to book events… even if they are interested in the topic, because they are afraid that their presence will announce to their community that their children have issues. And they don’t want to be thought of as being a parent of a child with mental health issues.