Neuroethical issues in the diagnosis and treatment of children with mood and behavioral disturbances

Abstract

The number of children in the United States receiving psychiatric diagnoses and taking psychotropic medications rose significantly from the second half of the twentieth century through to today. Accompanying these increased rates of diagnosis and psychotropic medication use have come sometimes intense debates about whether the increases are appropriate, or whether healthy children are being mislabeled as sick and inappropriately given medications to alter their moods and behaviors. While these debates are in part highly technical, concerning questions in epidemiology and pharmacology, they are also infused with ethical questions about the appropriate goals of medicine, the nature of sickness and health, and the obligations we owe to children and families struggling to flourish. This chapter presents four inter-connected observations about the diagnosis and treatment of mood and behavioral disturbances in children that at least partially explain why this area generates concern and controversy, but that also point to important areas of agreement where progress can be made. These observations include that psychiatry can provide an important approach for understanding and responding to children’s mood and behavioral problems provided we remember that it also carries its own complexities and difficulties. Further, forces within and outside psychiatry can influence how diagnoses are made and how treatments are selected, including systemic forces that strongly favor medication over psychosocial treatments, with the result that children too often receive pharmacological treatment only, even when other interventions are supported by evidence, contribute towards long-term flourishing, and reflect families’ deepest value commitments.