A report last month in the Canadian Journal of Psychiatry should be of great concern, because it appears the use of anti-psychotic drugs to treat children has quadrupled in recent years. And boys are much more often medicated than girls.

The statistics are alarming for two reasons. First, these mood-altering drugs are enormously powerful. Several are associated with serious side effects.

One 15-year study in the United States found that 1,207 children taking the anti-psychotic Risperdal experienced serious health problems, and 31 died. Among the fatalities was a nine-year-old with attention deficit/hyperactivity disorder who suffered a lethal stroke 12 days after starting treatment. Inappropriate prescribing practices may have played a role in some of these cases.

Another U.S. study found significant weight gain in 50 per cent of children treated with antipsychotics.

Heightened cholesterol readings and resistance to insulin were also reported.

Of course, the possibility of side effects must be assessed against the positive results a drug may offer. Sometimes the benefits outweigh the risks.

But the enormous flood of anti-psychotics noted in the Canadian report suggests that the risks are being heavily discounted.

A second reason for alarm is that few of these mood-altering medications have been tested on children. In itself, that's not surprising. Most drug trials are confined to adults, in part for safety reasons.

In the case of medications that are well tolerated by younger patients - some classes of antibiotics, for example - there is no cause for concern. But it's well known that antipsychotics are much harder on children than adults.

Beyond concerns for the safety of these drugs, there is also a question about need. The past two decades have seen a huge increase in the incidence of childhood behaviour disorders.

In the U.S., the number of school-age youngsters diagnosed with autism grew 20-fold between 1991 and 2001.

The number of kids found to have bipolar disorder jumped 40-fold.

The definition of a "disorder" has expanded to such an extent that one in five American children can now be classified as mentally ill.

It is difficult not to see, in this onslaught of diagnosis and medication, the path of least resistance. In earlier times, when parents brought their hyperactive child to a doctor, telling them to persevere was the only practical choice. Now, with a shelf full of drugs at hand, an easier solution beckons.

This is not to minimize in any way the very real challenges facing children with serious mood and behaviour disorders. Sometimes medication is not only the right answer, it is the only answer.

However, it does appear we are in turning a last resort into a first resort. And a first resort, moreover, that has not been properly weighed or tested.

In the B.C. health ministry, the director of Pharmacare has the authority to place dangerous or specialty drugs on a restricted list. It may be time to consider that option with anti-psychotic drugs for children.