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\par }\pard \ql \li0\ri0\sl-273\slmult0\widctlpar\pvpg\phpg\posx5337\posy4353\absh1483\absw4771\faauto\rin0\lin0\itap0 {\b\f0\fs22 Medicating }{\f0\fs22 Young }{\b\f0\fs22 
Minds: Drugs have become increasingly popular for treating kids with mood and behavior problems. But how will that affect them }{\f0\fs22 in }{\b\f0\fs22 the long run? }{\f0\fs22 (Health) (Cover Story) }{\i\f0\fs22 Jeffrey Kluger.
\par }\pard \ql \li0\ri0\sl-220\slmult0\widctlpar\pvpg\phpg\posx4737\posy5956\absh364\absw4132\faauto\rin0\lin0\itap0 {\b\f0\fs18 Full }{\f0\fs18 Text: COPYRIGHT 2003 Time, Inc.
\par }\pard \ql \li0\ri0\sl-220\slmult0\widctlpar\pvpg\phpg\posx10593\posy806\absh360\absw595\faauto\rin0\lin0\itap0 {\f2\fs18 of15
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4732\posy6499\absh840\absw5980\faauto\rin0\lin0\itap0 {\f0\fs22 Byline: Jeffrey Kluger With reporting by Dan Cray/Los Angeles, Alice Park/New York, Kathie Klarreich/Miami, and Leslie
 Whitaker/Jefferson City
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4722\posy7579\absh2990\absw5932\faauto\rin0\lin0\itap0 {\f0\fs22 
Getting by is hard enough in middle school. It's harder still when you've got other things on your mind--and Andrea Okeson, 13, had plenty to distract her. There were the constant stomach pains to consider; there was the nervousnes
s, the distractibility , the overwhelming need to be alone. And, of course, there was the business of repeatedly checking the locks on the doors. All these things grew, inexplicably, to consume Andrea, until by the time she was through with the eighth gra
de, she seemed pretty much through with everything else too." Andrea," said a teacher to her one day, "you look like death."
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The problem, though neither Andrea nor her teacher knew it, was that her adolescent brain was being tossed by the neurochemical ston
ns of generalized anxiety, obsessive- compulsive disorder (OCD) and attention- deficit'hyperactivity disorder (ADHD)--a decidedly lousy trifecta. If that was what eighth grade was, ninth was unimaginable.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4727\posy12921\absh2198\absw5913\faauto\rin0\lin0\itap0 {\f0\fs22 But that was then. Andrea, now 18, is a freshman at
 the College of St. Catherine in St. Paul, Minn., enjoying her friends and her studies and looking forward to a career in fashion merchandising, all thanks to a bit of chemical stabilizing provided by a pair of pills: Lexapro, an antidepressant, and Adder
all, a relatively new anti-adhd drug. "I feel excited about things," Andrea says. "I feel like I got me back."
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\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1079\posy801\absh350\absw916\faauto\rin0\lin0\itap0 {\b\f0 Article }{\f0 I
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9882\posy772\absh403\absw1320\faauto\rin0\lin0\itap0 {\b Page }{2 }{\b of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4746\posy1804\absh3532\absw5947\faauto\rin0\lin0\itap0 {\f0\fs22 So a little medicine fixed what ailed 
a child. Good news all around, right? Well, yes--and no. Lexapro is the perfect answer for anxiety all right, provided you're willing to overlook the fact that it does its work by artificially manipulating the very chemicals responsible for feeling and th
o
ught. Adderall is the perfect answer for adhd, provided you overlook the fact that it's a stimulant like Dexedrine. Oh, yes, you also have to overlook the fact that the Adderall has left Andrea with such side effects as weight loss and sleeplessness, and 
both drugs are being poured into a young brain that has years to go before it's fmally fully formed.
\par }\pard \ql \li0\ri0\sl-268\slmult0\widctlpar\pvpg\phpg\posx4746\posy1804\absh3532\absw5947\faauto\rin0\lin0\itap0 {\f0\fs22 Still, says Andrea, "I'm just glad there were things that could be done."
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4746\posy5534\absh1401\absw5952\faauto\rin0\lin0\itap0 {\f0\fs22 Those things--whether Lexapro or Ritalin or Prozac or something else--are being do
ne for more and more American children. In fact, they are being done with such frequency that some people have justifiably begun to ask, Are we raising Generation Rx?
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy7142\absh4574\absw5942\faauto\rin0\lin0\itap0 {\f0\fs22 Just a few years ago, psychologists couldn't say with certainty that kids were even capab
le of suffering from depression the same way adults do. Now, according to PhRMA, a pharmaceutical trade group, up to 10% of all American kids may suffer from some mental illness. Perhaps twice that many have exhibited some symptoms of depression. Up to a 
m
illion others may suffer from the alternately depressive and manic mood swings ofbipolar disorder (BPD), one more condition that was thought until recently to be an affliction of adults alone. ADHD rates are exploding too. According to a Mayo Clinic study
,
 children between 5 and 19 have at least a 7.5% chance of being found to have ADHD, which amounts to nearly 5 million kids. Other children are receiving diagnoses and medication for obsessive-compulsive disorder, social-anxiety disorder, post- traumatic s
tress disorder (PTSD), pathological impulsiveness, sleeplessness, phobias and more.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4727\posy11932\absh2712\absw5918\faauto\rin0\lin0\itap0 {\f0\fs22 
Has the world--and American society in particular--simply become a more destabilizing place in which to raise children? Probably so. But other factors are at work, including
 sharp-eyed parents and doctors with a rising awareness of childhood mental illness and what can be done for it. "While we don't know exactly why the incidence of psychopathology is increasing in children and adolescents, it probably has to do with better
 diagnosis and detection," says Dr. Ronald Brown, professor of pediatrics at the Medical University of South Carolina.
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4727\posy14880\absh331\absw5673\faauto\rin0\lin0\itap0 {\f0\fs22 Also feeding the trend for more diagnoses is the arrival of
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1041\posy15868\absh321\absw8889\faauto\rin0\lin0\itap0 {\b\f0 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 5/7 44/ 44277236w2/purl=rc }{\f0 1 }{\b\f0 ITOF }{\f0 0. ..
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx10113\posy15816\absh494\absw1084\faauto\rin0\lin0\itap0 {\f0\fs22 12/4/2003
\par }{\fs2 \sect }\sectd \margrsxn1113\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-182\slmult0\widctlpar\pvpg\phpg\posx1069\posy801\absh350\absw768\faauto\rin0\lin0\itap0 {\f2\fs14 Article
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9873\posy811\absh321\absw1286\faauto\rin0\lin0\itap0 {\b Page }{3 }{\b of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4746\posy1800\absh2995\absw5928\faauto\rin0\lin0\itap0 {\f0\fs22 whole new classes of psychotropic drugs with fewer side effects and greater efficacy than earlier medications, particu
larly the selective serotonin reuptake inhibitors (SSRIs), or antidepressants. These have been rolled out with highly visible, to-the-consumer ad campaigns. While an earlier generation of antidepressants--tricyclics like Tofranil- -didn't work in kids, SS
RIs do. According to a study by Professor Julie Zito of the University of Maryland School of Pharmacy, use of antidepressants among children and teens increased threefold between 1987 and 1996. And that use continues to climb.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy4996\absh5640\absw5976\faauto\rin0\lin0\itap0 {\f0\fs22 Nobody, not even the drug comp
anies, argues that pills alone are the ideal answer to mental illness. Most experts believe that drugs are most effective when combined with talk therapy or other counseling. Nonetheless, the American Academy of Child and Adolescent Psychiatry now lists d
o
zens of medications available for troubled kids, from the comparatively familiar Ritalin (for ADHD) to Zoloft and Celexa (for depression) to less familiar ones like Seroquel, Tegretol, Depakote (for bipolar disorder), and more are coming along all the tim
e
. There are stimulants, mood stabilizers, sleep medications, antidepressants, anticonvulsants, antipsychotics, anti anxieties and narrowcast drugs to deal with impulsiveness and post-traumatic flashbacks. A few of the newest meds were developed or approve
d
 specifically for kids. The majority have been okayed for adults only, but are being used "offlabel" for younger and younger patients at children's menu doses. The practice is common and perfectly legal but potentially risky. "We know that kids are not ju
st little adults," says Dr. David Fassler, professor ofpsychiatry at the University ofVermont. "They metabolize medications differently."
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4732\posy10848\absh2462\absw5980\faauto\rin0\lin0\itap0 {\f0\fs22 Within the medical community--to say nothing of the
\par }\pard \ql \li0\ri0\sb4\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy10848\absh2462\absw5980\faauto\rin0\lin0\itap0 {\f0\fs22 families of the troubled kids--concem is growing about just what ps
ychotropic drugs can do to still developing brains. Few people deny that mind pills help--ask the untold
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy10848\absh2462\absw5980\faauto\rin0\lin0\itap0 {\f0\fs22 numbers who have climbed out of depressive pits or shaken off bipolar fits thanks to modem pharmacology .But few
\par }\pard \ql \li0\ri0\sl-268\slmult0\widctlpar\pvpg\phpg\posx4732\posy10848\absh2462\absw5980\faauto\rin0\lin0\itap0 {\f0\fs22 deny either that we're a quick-fix cul
ture, and if you give us a feel-good answer to a complicated problem, we'll use it with little thought of long-term consequences.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4727\posy13521\absh1406\absw5846\faauto\rin0\lin0\itap0 {\f0\fs22 "The problem," warns Dr. Glen Elliott, director of the Langley Porter Psychiatric Institute's children's center at the
 University of California, San Francisco, "is that our usage has outstripped our knowledge base. Let's face it, we're experimenting on these kids without tracking the results."
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1013\posy15787\absh124\absw124\faauto\rin0\lin0\itap0 {~
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx10117\posy15811\absh475\absw1080\faauto\rin0\lin0\itap0 {\f0\fs22 12/4/2003
\par }{\fs2 \sect }\sectd \pghsxn16780\margrsxn1113\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-139\slmult0\widctlpar\pvpg\phpg\posx1074\posy787\absh364\absw921\faauto\rin0\lin0\itap0 {\b\f0\fs10 Article }{\f0\fs10 1
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9877\posy748\absh408\absw1315\faauto\rin0\lin0\itap0 {\b Page }{4 }{\b of 15
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4756\posy1795\absh345\absw3336\faauto\rin0\lin0\itap0 {\f0\fs22 THE CASE FOR MEDICATION
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4741\posy2332\absh3259\absw5990\faauto\rin0\lin0\itap0 {\f0\fs22 Th
ose experiments, however, are often driven by dire need. When a child is suffering or suicidal, is it fair not to turn to the prescription pad in conjunction with therapy? Is it even safe? Untreated depression has a lifetime suicide rate of 15%--with stil
l
 more deaths caused by related behaviors like self-medicating with alcohol and drugs. Kids with severe and untreated ADHD have been linked, according to some studies, to higher rates of substance abuse, dropping out of school and trouble with the law. Bip
olar kids have a
\par }\pard \ql \li0\ri0\sb4\sl-264\slmult0\widctlpar\pvpg\phpg\posx4741\posy2332\absh3259\absw5990\faauto\rin0\lin0\itap0 {\f0\fs22 
tendency to injure and kill themselves and others with uncontrolled behavior like brawling or reckless driving. They are also more prone to suicide.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4722\posy5750\absh6240\absw5990\faauto\rin0\lin0\itap0 {\f0\fs22 Which is why Teresa Hatten of Fort Way
ne, Ind., hesitated little when it came time to put her granddaughter Monica on medication. Hatten's grown daughter, Monica's mom, suffers from bipolar disorder, and so does Monica, 13. To give Monica a chance at a stable upbringing, Hatten took on the jo
b
 of raising her, and one of the first things she had to do was get the violent mood swings of the bipolar disorder under control. It's been a long, tough slog. An initial drug combination of Ritalin and Prozac, prescribed when Monica was 6, simply collaps
e
d her alternating depressed and manic moods into a single state with sad and wild features. By the time she was 8, her behavior was so unhinged, her school tried to expel her. Next Monica was switched to Zyprexa, an antipsychotic, that led to serious weig
h
t gain. "At 12 years old she had stretch marks," says Hat ten. Now, a year later, Monica is taking a four-drug cocktail that includes Tegretol, an anticonvulsant, and Abilify , an antipsychotic. That, at last, seems to have solved the problem. "She's the 
b
est I've ever seen her," says Hatten. "She's smiling. Her moods are consistent. I'm cautiously optimistic." Monica agrees: "I'm in a better mood." Next up in the family's wellness campaign: Monica's 8-year-old cousin Jamari, who is on Zyprexa for a mood d
isorder.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy12177\absh2203\absw5976\faauto\rin0\lin0\itap0 {\f0\fs22 
All along the disorder spectrum there are such phannacological success stories. In the October issue of the Archives of General Psychiatry, Dr. Mark Olfson of the New York State Psychiatric Institute reports that every time the use of antidepressan
ts jumps 1 %, suicide rates among kids
\par }\pard \ql \li0\ri0\sb4\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy12177\absh2203\absw5976\faauto\rin0\lin0\itap0 {\f0\fs22 
10 to 19 decrease, although only slightly. But that doesn't include the nonsuicidal depressed kids whose misery is eased thanks to the same pills.
\par }\pard \ql \li0\ri0\sl-268\slmult0\widctlpar\pvpg\phpg\posx4737\posy14601\absh619\absw4132\faauto\rin0\lin0\itap0 {\f0 ARE WE MEDDLING WITH NORMAL DEVELOPMENT?
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1045\posy15854\absh316\absw8894\faauto\rin0\lin0\itap0 {\b\f0 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 5/7 44/ 4427723 6w2/purl=rc }{\f0 1 }{\b\f0 ITOF }{\f0 0. ..
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx10122\posy15801\absh475\absw1080\faauto\rin0\lin0\itap0 {\f0\fs22 12/4/2003
\par }{\fs2 \sect }\sectd \margrsxn1075\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-139\slmult0\widctlpar\pvpg\phpg\posx1093\posy792\absh360\absw926\faauto\rin0\lin0\itap0 {\b\f0\fs10 Article }{\f0\fs10 1
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9906\posy816\absh336\absw1291\faauto\rin0\lin0\itap0 {\b\f0 Page }{\f0 5 }{\b\f0 of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4770\posy1800\absh2198\absw6014\faauto\rin0\lin0\itap0 {\f0\fs22 For children with less severe problems--children who are somber but not depressed, antsy but not clinically hyperactiv
e, who rely on some repetitive behaviors for comfort but are not patently obsessive compulsive--the pros and cons of using drugs are far less obvious. "Unless there is careful assessment, we might start medicating nonnal variations [in behavior]," says St
ephen Hinshaw, chainnan of psychology at the University of California, Berkeley.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4761\posy4204\absh4041\absw5923\faauto\rin0\lin0\itap0 {\f0\fs22 
The world would be a far less interesting place if all the eccentric kids were medicated toward some golden mean. Besides, there are just too many unanswered questions about gi
ving mind drugs to kids to feel comfortable with ever broadening usage. What worries some doctors is that if you medicate a child's developing brain, you may be burning the village to save it. What does any kind of psychopharmacological meddling do, not j
u
st to brain chemistry but also to the acquisition of emotional skills-- when, for example, antianxiety drugs are prescribed for a child who has not yet acquired the experience of managing stress without the meds? And what about side effects, from weight g
ain to jitteriness to flattened personality--all the things you don't want in the social crucible of grade school and, worse, high school.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4756\posy8467\absh1929\absw5932\faauto\rin0\lin0\itap0 {\f0\fs22 Adding to the worries is a growing body of knowledge showing just how incompletely fonned a child's brain truly is. "W
e now know from imaging studies that frontal lobes, which are vital to executive functions like managing feelings and thought, don't fully mature until age 30," says Hinshaw. That's a lot of time for drugs to muck around with cerebral clay.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4746\posy10603\absh2193\absw5707\faauto\rin0\lin0\itap0 {\f0\fs22 For that reason
, it may not always be worth pulling the pharmacological rip cord, particularly when symptoms are relatively mild. Child psychologists point out that often nonpharmaceutical treatments can reduce or eliminate the need for drugs. Anxiety disorders such as 
phobias can respond well to behavioral therapy--in which patients are gently exposed to graduated levels of the very things they fear until the brain habituates to the escalating risk.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4741\posy13008\absh2203\absw5803\faauto\rin0\lin0\itap0 {\f0\fs22 Depression too may respond to new, streamlined therapy techniques, espec
ially cognitive therapy--a treatment aimed at helping patients reframe their view of the world so that setbacks and losses are put in less catastrophic perspective. "The therapist teaches relaxation skills and positive thinking," says Denise Chavira, clin
ical psychologist at the University of California at San Diego. "It goes beyond talk therapy." Unfortunately, medical insurance pays more
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx1050\posy15859\absh331\absw8774\faauto\rin0\lin0\itap0 {\f0\fs22 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 5/7 44/ 4427723 6w2/purl=rc 1 }{\b\f0\fs22 ITOF }{\f0\fs22 0.
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx10132\posy15816\absh494\absw1080\faauto\rin0\lin0\itap0 {\f0 12/4/2003
\par }{\fs2 \sect }\sectd \margrsxn1075\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-158\slmult0\widctlpar\pvpg\phpg\posx1093\posy792\absh360\absw926\faauto\rin0\lin0\itap0 {\b\f0\fs12 Article }{\f0\fs12 1
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9911\posy820\absh336\absw1286\faauto\rin0\lin0\itap0 {\b Page }{6 }{\b of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4780\posy1804\absh614\absw5582\faauto\rin0\lin0\itap0 {\f0\fs22 readily for pills than these other treatments for adults and children.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4770\posy2611\absh2750\absw5860\faauto\rin0\lin0\itap0 {\f0\fs22 For kids with more serious symptoms, experts are worried that undermedicating is a bigger risk than overmedicating. "S
ay you've got a kid who's severely obsessive and literally can't leave the home because of the fears and rituals he's got to perform," says UCSF's Elliott. "Think about what anyone age 2 to age 16 has to learn to function in our society. Then think about 
losing two of those years to a disorder. Which two would you choose to lose?" Also on the side of intervention is the belief that treating more kids with mental illness could reduce its incidence in adults.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4746\posy5553\absh3787\absw6009\faauto\rin0\lin0\itap0 {\f0\fs22 Dr. Kiki Chang at Stanford University is trying to
 show that this is true with bipolar kids. He recently published a study in the Journal of Clinical Psychiatry that looked at kids from bipolar families who had only early signs of the disease. Pre- emptive doses ofDepakote eased early symptoms in 78% of 
cases before the illness ever had a chance to take hold. "You can sit and watch it develop or intervene and possibly
\par }\pard \ql \li0\ri0\sb4\sl-259\slmult0\widctlpar\pvpg\phpg\posx4746\posy5553\absh3787\absw6009\faauto\rin0\lin0\itap0 {\f0\fs22 
prevent the disorder," says Chang. While the researcher is excited about his results, he admits that treating kids who are not yet truly sic
k is controversial. "There's a chance some of the kids might not develop bipolar at all," says Chang. "We need to have more genetics, more brain imaging, more biological markers to know which direction the kids are going."
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4751\posy9552\absh360\absw4468\faauto\rin0\lin0\itap0 {\f0\fs22 HOW CAN WE MEASURE THE RESULT?
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4737\posy10104\absh2721\absw5913\faauto\rin0\lin0\itap0 {\f0\fs22 Pr
eventing symptoms, of course, is not everything. A sleeping child is completely asymptomatic, for example, but that's not the same as being fully functioning. If the drugs that extinguish symptoms also alter the still developing brain, the cure may come a
t
 too high a price, at least for kids who are only mildly symptomatic. To determine if this kind of damage is being done, investigators have been turning more and more to brain scans such as magnetic resonance imaging (MRI). The results they're getting hav
e been intriguing.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy13032\absh1915\absw5913\faauto\rin0\lin0\itap0 {\f0\fs22 
MRls had already shown that the brain volumes ofkids with ADHD are 3% smaller than those ofunafflicted kids. That concerned researchers since nearly all those scans had been taken of children already being medicated for the disorder. Were
 the anatomical differences there to begin with, or were they caused by the drugs? Attempting to answer that, Dr. F . Xavier Castellanos of the New York University Child
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1041\posy15864\absh321\absw8836\faauto\rin0\lin0\itap0 {\b\f0 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 5/7441 442 77236w2/purl=rc }{\f0 1 }{\b\f0 ITOF 0. }{\f0 .
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx10122\posy15816\absh494\absw1080\faauto\rin0\lin0\itap0 {\f2 12/4/2003
\par }{\fs2 \sect }\sectd \pghsxn16780\marglsxn1075\margrsxn1017\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-139\slmult0\widctlpar\pvpg\phpg\posx1156\posy792\absh364\absw926\faauto\rin0\lin0\itap0 {\b\f0\fs10 Article }{\f0\fs10 1
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9974\posy816\absh331\absw1291\faauto\rin0\lin0\itap0 {\b Page }{7 }{\b of 15
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4843\posy1800\absh1392\absw5985\faauto\rin0\lin0\itap0 {\f0\fs22 
Studies Center took other scans, this time using only kids with ADHD and comparing those who were taking medication with those who were not. Reassuringly, he discovered that they all shared the same
 structural anomaly, a finding that seems to exonerate the drugs.
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4828\posy3403\absh2438\absw6004\faauto\rin0\lin0\itap0 {\f0\fs22 
Dr. Steven Pliszka, chief of child psychiatry at the University of Texas Health Center in San Antonio, went further. He conducted scans that picked up not just the structure but the activity
 of the brains of untreated ADHD children, and compared these images with those from children who had been medicated for a year or more. The treated group showed no signs of any deficits in brain function as measured in blood flow. In fact, he says, "we s
aw hints of improvement toward normal. "
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4823\posy6076\absh2212\absw5918\faauto\rin0\lin0\itap0 {\f0\fs22 
The news was less positive when it came to bipolar disorder. Chang has looked at the brains of kids treated with Depakote, and while his study is as yet unpublished, he says he noticed some anatomical differences tha
t could result from treatment--and he wasn't necessarily happy with them. "We are seeing that medications do affect the brain acutely," he says. "Is that a good thing, a bad thing? We just don't know."
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4819\posy8486\absh2188\absw5937\faauto\rin0\lin0\itap0 {\f0\fs22 What nobody denies is that more research is needed to 
resolve all these questions--and that it won't be easy to get it started. The first problem is one of time. It was only in the early 1990s that the antidepressant Prozac exploded into pharmacies. It's hard to do a lifetime of longitudinal studies on a dru
g that's been widely used for just over a decade. And each time the industry invents a new medication, the clock rewinds to zero for that particular pill.
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4809\posy10886\absh4324\absw6000\faauto\rin0\lin0\itap0 {\f0\fs22 Even if it were possible to conduct extended studies, getting volunteers for the work is difficult. Th
e attrition rate is high in any years-long research, especially so when the subjects are kids, who bore easily and, at any rate, eventually go away to college. On average, 40% of children will drop out of a long-tenn study before the work is done. And tha
t
 assumes their parents will even sign them up in the first place. Some brain scans involve at least a little bit of radiation--something most parents are reluctant to expose their children to, particularly if those kids have no emotional disorders and are
 
simply being used as a baseline to establish the look of a healthy brain. Getting good scans from kids who have diagnosable conditions isn't easy, as any radiologist who has ever tried to conduct a lengthy MRI on a child with ADHD can attest. "Holding sti
ll is not exactly what they do well," says Elliott.
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx1118\posy15864\absh302\absw8899\faauto\rin0\lin0\itap0 {\f0\fs22 http:/ /web2.infotrac.gale~oup.corn/itw /infomark/63 5/7 44/ 4427723 6w2/purl=rc 1 }{\b\f0\fs22 ITOF }{\f0\fs22 0.. .
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx10204\posy15820\absh475\absw1075\faauto\rin0\lin0\itap0 {\f0 12/4/2003
\par }{\fs2 \sect }\sectd \pghsxn16780\margrsxn1113\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1055\posy811\absh350\absw916\faauto\rin0\lin0\itap0 {\b\f0 Article }{\f0 I
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9868\posy806\absh331\absw1291\faauto\rin0\lin0\itap0 {\b Page }{8 }{\b of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4737\posy1800\absh1665\absw5947\faauto\rin0\lin0\itap0 {\f0\fs22 Ethical questions hamstring research t
oo. Any gold-standard study requires that some of the kids who are suffering from a disorder receive no drugs so that they can be compared with the kids who do. But if you believe the medications are helpful, how can you withhold them from a group of symp
tomatic children who need them?
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy3672\absh3523\absw5952\faauto\rin0\lin0\itap0 {\f0\fs22 
Despite such obstacles, research is moving ahead, if haltingly. The National Institute of Mental Health is conducting a study called the Preschool ADHD Treatment Study, in which researchers will track ADHD kids between 3 and 
8 years old to determine the benefits and side effects of stimulant medications. Castellanos and N.Y.U. colleague Rachel Klein are taking things further, calling back subjects who were enrolled in an ADHD-treatment study that began in 1970 to scan their n
ow late-30s and early-40s brains for the long-term effects of drugs. Castellanos is also planning a study of young rats treated with varying amounts of psychotropic drugs, conducting dosing and anatomical studies that cannot be performed on humans.
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4732\posy7406\absh350\absw4262\faauto\rin0\lin0\itap0 {\f0\fs22 THE RISK OF HASTY PRESCRIPTIONS
\par }\pard \ql \li0\ri0\sl-268\slmult0\widctlpar\pvpg\phpg\posx4727\posy7948\absh3288\absw5961\faauto\rin0\lin0\itap0 {\f0\fs22 Just as important as getting the research rolling is fixing the health-care system kids rely on to get well. Like adults
\par }\pard \ql \li0\ri0\sb9\sl-259\slmult0\widctlpar\pvpg\phpg\posx4727\posy7948\absh3288\absw5961\faauto\rin0\lin0\itap0 {\f0\fs22 taking mind meds, children often get their drugs not from a specialist in psychiatry and psychopharmacology but
 from any M.D. with the power of the prescription pad. Usually
\par }\pard \ql \li0\ri0\sb4\sl-264\slmult0\widctlpar\pvpg\phpg\posx4727\posy7948\absh3288\absw5961\faauto\rin0\lin0\itap0 {\f0\fs22 
this means the pediatrician or family doctor, who isn't likely to have the time or training necessary for the extensive evaluations needed before drugs can be properly prescrib
ed-- much less the required follow-up visits. "There's no way you can screen for side effects in a lO-year-old in five minutes," says Miami neurologist Sara Dorison. "You have to chat about their summer, their friends."
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4727\posy11419\absh2721\absw5952\faauto\rin0\lin0\itap0 {\f0\fs22 Part of the reason for all the hurry
-up drugging, say psychiatrists, is managed care, which, already disinclined to pay for longer, more costly talk therapy, is equally reluctant to foot the bill to make sure patients on pills are well monitored. In a perfect--or at least better--world, say
s
 Elliott, parents considering meds for their kids would have access not to one specialist but three: a pediatrician, a behavioral pediatrician and a child-adolescent psychiatrist. "Insurance companies talk about second opinions, " he says, "but they don't
 actually like them."
\par }\pard \qj \li0\ri72\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy14361\absh604\absw5688\faauto\rin72\lin0\itap0 {\f0\fs22 The phannaceutical companies could be doing better too-- and if they don't, the government must push them to do it.
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1045\posy15868\absh292\absw8889\faauto\rin0\lin0\itap0 {\b\f0 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 5/7 44/ 4427723 6w2/purl=rc }{\f0 1 }{\b\f0 ITOF }{\f0 0. ..
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx10127\posy15811\absh475\absw1080\faauto\rin0\lin0\itap0 {\f0\fs22 12/4/2003
\par }{\fs2 \sect }\sectd \marglsxn998\linex0\sectdefaultcl \pard\plain \ql \li0\ri0\widctlpar\faauto\rin0\lin0\itap0 \f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs12 
\par }\pard \ql \li0\ri0\sl-120\slmult0\widctlpar\pvpg\phpg\posx360\posy540\absh-120\absw1440\faauto\rin0\lin0\itap0 {\fs12 
\par }\pard \ql \li0\ri0\sl-139\slmult0\widctlpar\pvpg\phpg\posx1094\posy792\absh360\absw921\faauto\rin0\lin0\itap0 {\b\f0\fs10 Article }{\f0\fs10 1
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx9906\posy777\absh403\absw1310\faauto\rin0\lin0\itap0 {\b Page }{9 }{\b of 15
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4761\posy1804\absh3528\absw6000\faauto\rin0\lin0\itap0 {\f0\fs22 
There is a lot of money to be made in developing the next Prozac, but there is less profit if you test it for longer than the law demands. The Food and Drug Administration (FDA) doesn't require long-term studies that follow patient
s over decades. Its only requirement is toxicity trials that span six to eight weeks. In an effort to entice companies to conduct lengthier studies, the agency now grants an extension of six months of exclusive marketing rights to any company engaging in 
s
tudies of a drug's effects on a minimum of 100 children for more than six months. "It's a relatively small amount of data," acknowledges Dr. Thomas Laughren, a psychiatrist with the FDA's psychopharmacology division, "but it's better than what we had befo
re, which was nothing."
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4751\posy5534\absh3537\absw5985\faauto\rin0\lin0\itap0 {\f0\fs22 
Until all these things happen, the heaviest lifting will, as always, be left to the family. Perhaps the most powerful medicine a suffering child needs is the educated instincts of a well-informed parent--one who has taken the time to study
\par up on all the pharmaceutical and nonpharmaceutical options and pick the right ones. There will always be dangers associated with taking too many drugs--and also dangers from taking too few. "Like every other choice
 you make for your kids," says Chang, "you make right ones and wrong ones." When the health of a child's mind is on the line,
\par }\pard \ql \li0\ri0\sl-268\slmult0\widctlpar\pvpg\phpg\posx4751\posy5534\absh3537\absw5985\faauto\rin0\lin0\itap0 {\f0\fs22 getting it wrong is something that no parent wants. --With reporting by Dan Cray/Los Angeles, Alice Park/New York, Kathie Klarreic
h/Miami, and Leslie Whitaker/Jefferson City
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx4761\posy9264\absh436\absw840\faauto\rin0\lin0\itap0 {\f0 [BOX:]
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4746\posy9820\absh360\absw4732\faauto\rin0\lin0\itap0 {\f0\fs22 PILLS }{\i\f0\fs22 FOR }{\f0\fs22 CHILDREN: HOW THEY WORK
\par }\pard \qj \li0\ri432\sl-259\slmult0\widctlpar\pvpg\phpg\posx4742\posy10363\absh1137\absw5918\faauto\rin432\lin0\itap0 {\f0\fs22 Children are just as vulnerable as adults to mental illness.
\par }\pard \qj \li0\ri72\sl-264\slmult0\widctlpar\pvpg\phpg\posx4742\posy10363\absh1137\absw5918\faauto\rin72\lin0\itap0 {\f0\fs22 But though the pharmaceutical pantry is filling up with more medications designed and tested for kids, in some
 cases they still have to settle for smaller doses of drugs made for adults
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4742\posy11707\absh350\absw1392\faauto\rin0\lin0\itap0 {\f2\fs22 ADDERALL
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4742\posy12254\absh350\absw1876\faauto\rin0\lin0\itap0 {\f0\fs22 HOW IT WORKS
\par }\pard \ql \li0\ri0\sl-264\slmult0\widctlpar\pvpg\phpg\posx4732\posy12806\absh600\absw5865\faauto\rin0\lin0\itap0 {\f0\fs22 A once-a-day amphetamine, it puts the brake on areas of the brain responsible for organizing thoughts
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx4742\posy13622\absh360\absw1684\faauto\rin0\lin0\itap0 {\f0\fs22 SIDE EFFECTS
\par }\pard \ql \li0\ri0\sl-278\slmult0\widctlpar\pvpg\phpg\posx4732\posy14169\absh633\absw5385\faauto\rin0\lin0\itap0 {\f0\fs22 Rapid heartbeat, high blood pressure and, in rare cases, overstimulation. It can also become addictive
\par }\pard \ql \li0\ri0\sl-240\slmult0\widctlpar\pvpg\phpg\posx1036\posy15864\absh321\absw8904\faauto\rin0\lin0\itap0 {\b\f0 http:/ /web2.infotrac.galegroup.com/itw/infomark/63 }{\f0 5/7441 }{\b\f0 4427723 6w2/purl=rc }{\f0 1 }{\b\f0 ITOF 0.. }{\f0 .
\par }\pard \ql \li0\ri0\sl-259\slmult0\widctlpar\pvpg\phpg\posx10118\posy15820\absh494\absw1084\faauto\rin0\lin0\itap0 {\f0\fs22 12/4/2003
\par }}