by A.F. Hutchinson
, Copywriter | February 03, 2010
For 35 years, Robert Lehman, M.D. has operated a child and adolescent psychiatry practice in Baltimore. "What I definitively see in the course of the years is that there is an increased severity of symptoms and behaviors in the children that come to my office. I'm treating more difficult, more multi-handicapped, more severely impaired children now then I was at the outset of my practice." He points to an increase in incidence as the cause. "It's not that there is more illness out there. It's recognized more. There is less of a stigma, and there is more willingness for pediatricians to treat ADD and for pediatricians to refer and primary care physicians to treat and to refer, and there's a greater willingness on the part of the parents to go along with it. There is something that has changed, but I don't think incidence of childhood depression has increased; I think it's the idea then of identification, recognition, and diagnosis that has improved." He adds, "There is no question that there are more children on medication. That doesn't mean that there's an increased incidence of ADD. It's an increased recognition and willingness on the part of the provider and on the part of parents to allow pharmacologic intervention."
In addition to private practice and his role as Clinical Assistant Professor in the psychiatry department at the University of Maryland, Lehman is a founder of Pharmasite Research, a clinical trial management firm. He's candid about the influential role of the pharmaceutical industry in academic research. What does he think of Big Pharma's influence on pediatric psychiatry? "That's the price you pay for progress," he asserts. "You try to be an intellectual and thinking person when you read clinical trials, and when you read about the medications coming out, and you have to be intellectually honest with yourself about trying to make as good a diagnosis (as possible). But I would challenge any one of these people who say we're over-medicating to deny some of the claims of responses that I'm able to establish relatively easily with children. There are people that will be critical of multi-medicine use in children with no clinical trial evidence to support it. Polypharmacy in children is very common now, particularly in very disruptive children who get labeled as bipolar children. I've done three or four bipolar child trials; if every person was labeled bipolar, I'd have no trouble recruiting for those trials. It's very difficult to make an accurate diagnosis of bipolar, but if you have a kid that somebody's labeled as bipolar who is six years old and is running out of the house impulsively in downtown Baltimore where the distance between the front stoop and the street is about four feet, that's dangerous."