Hi, I'm Rauf Aliev.

Today I dug up something interesting about kids and pills.

Local doctors are somewhat surprised that I’m not on any medication. Recently, an acquaintance of a doctor said in passing that he has lots of young patients who regularly take 12–14 pills a day. I started researching — and my eyes nearly popped out.

I found that according to CDC data, nearly one in five children under 12 years old are on prescription drugs. In the 12–19 age cohort, it’s every third one. Moreover, the rate among boys up to 12 years old is one and a half times higher than among girls, which is largely explained by early ADHD diagnoses. If we’re talking about long-term use (3 months or more continuously), a fifth of all children and teenagers are involved. It is reported that ADHD was diagnosed in 11.4% of children, about 7 million people, approximately every ninth child in the country. Of those with an active diagnosis, 53.6% are taking stimulants (Adderall, Ritalin, Concerta, and equivalents). In terms of the entire child population, this means about 6% of American children are constantly on psychostimulants. Besides ADHD, there are antidepressants, anti-anxiety meds, and antipsychotics. 9.3% of all children ages 5–17 have taken some kind of “mental health” medication. Among teenagers 12–17 years old — 10.7%.

This is probably the most interesting thing I’ve found. The variability between states is threefold. In Louisiana, ADHD is diagnosed in nearly every fifth child, in California – three times less often. In Louisiana 80.2% of the diagnosed children were immediately put on medication, in California – 66.7%. The southern cluster (Louisiana, Mississippi, Alabama, South Carolina) consistently shows the highest figures.

Even more interesting is the breakdown by urbanization. In large metropolises, 7.1% of children take psychotropic drugs, in small towns — 8.5%, in rural areas — 12.1%. Yet, the proportion of those receiving psychotherapy is the same everywhere — about 11–13%. Why is that? Because rural areas disastrously lack psychologists and behavioral specialists, and the pill becomes the only alternative.

There’s a separate phenomenon — polypharmacy. This is the simultaneous use of 2+ drugs for over a month. Growth from 1.8% in the early 2000s to 3.3% today. About 300,000 American children regularly take three or more classes of psychotropic substances at the same time. And for children with complex chronic conditions (Children with Medical Complexity), the situation is completely off: 52.7% take 5+ medications daily, and 19.5% take more than 10 medications per day. Thus, the stories about 12–14 pills a day. Reports say that approximately every 12th child in the USA, taking multiple drugs concurrently, risks serious drug interaction. For teenage girls on combination therapy, this risk reaches 20%.

Reading why this has happened.

It turns out that here the child’s psyche is increasingly perceived as neurochemistry that needs to be corrected with a pill, rather than as a result of sleep, stress, family environment, and a heap of other factors. Or at least the parents understand that since the rest is not fixed, the pills are an easy way out. Deprescribing (planned drug withdrawal) is hardly practiced — it’s easier to prescribe than to take off.

Secondly, rates for commercial insurance visits to a psychotherapist are on average 22% lower than for a visit to a somatic specialist. As a result, 18.2% of psychologists operate outside insurance networks (compared to 1.7% of somatic specialists). Our family pays an average of $1507 a year for psychotherapy on top of the insurance. But the pill is covered by the formulary, and the prescription copay is minimal. What choice will a tired family make? Why we are unable to raise children without mental health issues is another big topic.

Well, and another interesting point. According to our laws, an official ADHD diagnosis requires the school to provide the child with “Sec 504”: double time on tests, reduced homework, a separate quiet room for exams, allowed breaks during lessons. In the race for college admission, many parents from affluent layers consciously go for a diagnosis — it’s a legal way to give a child an advantage. And here’s the delicate part: Sec 504 specifically forbids the school from considering the effect of “mitigating measures,” which the law counts as medication. Meaning, even if the child on medication is fully functional and excels in studies — their privileges are maintained. There is simply no incentive for the family to decrease the dosage or get off the drug. The system is set up to keep the child on medication until graduation.