Toddlers and Prozac: prescriptions not solution

Two weeks ago researchers at the University of Maryland reported that doctors have doubled or tripled the use of psychotropic drugs like Prozac in treating two to four year-old children between 1991 and 1995.

Treating them for what?

Toddlers are an interesting lot. I have firsthand experience with a lively, energetic, yet floridly mischievous and saucy three year-old – my niece. A fascinating character, she will come up to me and profess unbounded love and affection for me, kiss me or hug me, and then in the next minute, like a little viper, she’ll spit at me and cackle uproariously, and kick me if I show the slightest hint of annoyance.

When I offer to read to her, she eagerly finds a favorite – usually “Little Red Riding Hood” or some fantastically violent fairytale – searches about for a blanket and a stuffed animal and curls up, a neat little bundle beside me while I begin to read. About two pages into the story, her intelligent little mind yearns to break free of the confines of hearing the same old story over and over again and she smacks me. I question her why she hit me, and she responds, “I didn’t hit you. I smacked you.”

“Oh,” I say, “good answer.”

Later on, my sister and I go on a walk with my niece to catch a breath of fresh air. After leaping about with boundless energy, chasing squirrels and chipmunks, and displaying her copious knowledge of the taxonomy of the birds in the trees, my niece comes up to us and says, “I can’t walk any more.” And plunks down on the muddy ground. “Why’s that?” I ask with mild condescension. “Because my legs are broken.” Becoming a bit impatient, my sister commands her daughter to get up and walk like a big girl, whereupon my niece throws a temper tantrum, screams, hollers and wails, tears streaming down her doll-turned-sour face: “But my legs won’t move! They can’t walk!” I then tempt her with ice cream when we get back, and the tantrum goes into full remission.

I am convinced my niece has borderline personality disorder. She exhibits “a pattern of intense, yet unstable, interpersonal relationships characterized by alternating between extremes of idealization and devaluation” (from my Abnormal Psychology textbook). She kisses me and hugs me, and turns around and spits at me and kicks me. What could be more idealizing and devaluing?

Actually, no. I’m convinced she has antisocial personality disorder. Those suffering from antisocial personality disorder are prone to deceitfulness, irritability and repeated aggressiveness. After manipulating me into reading to her in a comfortable environment, she whips around and physically attacks me. Furthermore, she shows no remorse after doing so: when I asked her to explain her behavior, she claimed, cutely, that she didn’t hit me, she smacked me.

Whoops, sorry. I must change diagnoses to account for the third scenario. She has bipolar disorder. After gleefully delighting in the simple joys of nature with effusive jollity, she tumultuously stumbles over to me and my sister, claiming utter helplessness, hopelessness and despair. On top of it all, maybe she has a dissociative disorder. That would explain why she depersonalizes herself from her legs that can’t walk.

Combining all of these grim disorders, I can only reach one conclusion. She’s a toddler! Although she’s three, she’s a Terrible Two; but, more importantly, an energetic, creative and intelligent one.

The question is: how many Terrible Twos are being improperly diagnosed in the interests of finding a quick fix for normal, but sometimes tiresome and taxing, behavior? I would wager that the vast majority is.

I duly apologize for subverting the criteria for various psychological disorders and for labeling my own niece with them, even if in the interests of satire. I apologize because psychological disorders need to be taken seriously and diagnosed with extreme care; and, furthermore, they must be treated by experienced, highly educated professionals who understand the implications of their therapeutic methods.

No doctor or psychiatrist who administers Prozac to a two to four year-old understands the implications of his therapeutic methods. Why? Because long-term side effects of Prozac have not been documented in adults. Furthermore, adding a powerful brain-chemistry-altering substance to the thick and spicy soup of a developing brain can have profound impacts. Consider the fact that a disease as innocuous as influenza, afflicting a woman in the second trimester of her pregnancy, has been identified as a possible cause of the most severe of mental disorders, schizophrenia, which becomes apparent usually as the brain is completing its development.

I can understand the necessary risk of prescribing anti-depressants to older children or adolescents who clearly demonstrate a risk of becoming suicidal. However, toddlers don’t even understand the concept of suicide; what is the risk of sticking out the Terrible Twos, which are a behavioral expression of neuro-anatomical growth? Certainly the risk of fundamentally altering brain chemistry during critical developmental periods outweighs the risk of putting up with annoying behavior from time to time.