I work at a large, influential, medical center with a top-notch Department of Psychiatry. I will say that treatment tends to be fairly conservative here, with regards to things like providing antibiotics for minor illnesses without clear evidence of a bacterial infection, or providing pain medication for something like low back pain. We're probably not representative of the US as a whole, especially as physicians here are salaried, rather than getting paid based on patients seen, or procedures preformed (a really great system that I wish more medical centers could put in place, but that's another story).
I have two friends who are child psychiatry fellows (fellows are physicians completing advanced specialty training beyond that required for a residency*). It's a field that I'm interested in, but I worry about the prevailing view that child psychiatry is all about putting small children on powerful medications that haven't really been studied in pediatric populations. So I went ahead and asked my friends what their experience was like with children and medications.
They both acknowledged that they see plenty of parents who come in demanding medications for their kids, often in response to what turn out to be fairly minor behavioral problems. They also see lots of referrals from outside medical centers, and some kids do come here on crazy amounts of medications (it's generally the small children diagnosed as bipolar, which is sort of a hot, but controversial, diagnosis right now, who end up on, say, five different meds).
Here, however, the emphasis is on psychotherapy, rather than psychopharmacology - the drugs are reserved for either patients with really clear diagnoses, or for patients who don't respond to more conservative treatments. This is apparently how physicians are trained here, as both of my friends independently gave me more or less the exact same answer.
One friend did, however, describe the ADHD medications as "the closest things to magical cures I've ever seen." For the patients who make really good candidates for the meds - and there aren't really that many, she said - the difference after a single dose can be dramatic. You can take a kid who cannot function, who literally cannot sit still, and you'll see them after they've been on medications for a short period of time, and they'll talk about being able to concentrate at school, read a book, etc. The kid will be much happier, the parents will be incredibly happy, the teachers will be happy. The problem is, it's just generally not that easy and not that quick. When it works, it's about as impressive as it gets in medicine, but not everyone needs the drugs or will respond well to them.
So that's how things are here, at any rate. This is a unique place, but we are a huge medical center, and one of the best in the world. There are certainly places where the standard of care is to churn through patients as quickly as possible, and that generally means some sloppy psychopharmacology, but that's not how physicians are trained everywhere. And it's probably as silly to completely dismiss ever putting any kid on psychiatric medications as it is to throw drugs at any kids who deviates the slightest bit from "the norm," whatever that is.
*Do people already know that? Most people I meet aren't really sure what the difference is between a medical student, an intern, a resident, and a fellow.
