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PBS Frontline: 'The Medicated Child'

Marcela Gaviria
Producer
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 George Foster 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."

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

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

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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.

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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.

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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.

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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.

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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.

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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.

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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 Christina is trying to keep D.J. calm.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 Christina 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.

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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 Jacob 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.

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Marcela Gaviria: Thanks for all your situation. And I hope you'll go to the Frontline site and continue the discussion.

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