The push to label

The dearth of approved drugs for pediatric use has prompted the two largest groups of mental-health professionals who treat children -- the American Psychological Assn. and the American Academy of Child and Adolescent Psychiatry -- to recommend that the FDA establish a new panel of independent experts to advise the agency on the safety and effectiveness of psychotropic drugs for children and adolescents. The AACAP has established a special working group to conduct and track research on preschool psychopharmacology, and another to focus on childhood bipolar disorder.

--

Wary of early intervention

Northwestern University's Christopher Lane, author of a new book, "Shyness: How Normal Behavior Became a Sickness," calls psychiatry's growing focus on children "the perfect storm" for overdiagnosis.

"You've got a constituency -- children -- who cannot make informed medical decisions for themselves," Lane says. In a fast-moving culture that heaps stress and high expectations on children, "parents are in many cases under great pressure to ensure their child succeeds and is socially proficient. A child that doesn't negotiate rapidly those hurdles can look very quickly as if he or she is falling behind, or displaying behavior that warrants medical concern."

Some mental-health professionals are wary, too, of the implied promise of early intervention. In fact, whether, how or in how many cases a child's problematic behavior leads to full-blown mental illness -- what health professionals call the "progression" of the disease -- is in many cases not well understood, especially when the patient is not even a teenager yet.

As to the claim that early treatment will lessen symptoms or prevent mental illness later, there is growing evidence, but it is hardly a slam-dunk. And it doesn't address which kids will benefit from pharmacological treatment and which won't.

As the mental-health profession begins debate over how to update its diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which is set for reissue in 2012, it is debating whether it has gone too far. The recent publication of two books critical of the expansion of psychiatric diagnoses -- Lane's "Shyness" and "The Loss of Sadness," by Allan V. Horwitz and Jerome C. Wakefield -- have touched off a flurry of discussion.