Up Close With Dr. E

To medicate or not: That is the question

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Parenting has never been, nor ever shall be, for the faint of heart. No, parenting is a gutsy and courageous task demanding that we, the parents, make hundreds and hundreds of decisions for our children. As your child’s primary caregiver, you hope and pray that by becoming a good parent, you will be able to open all the doors life has to offer for your child.

But, you cannot be a good parent until you first conquer fear. The fear parents must slay is that niggling itch which grows into parenting paranoia: What if I make a mistake, a big mistake? Well, since your child’s whole life - both present and future - is riding upon your ability to make the correct decisions, then it follows that a big parenting mistake has the power to negatively alter your child’s entire life.

It is this weight, carried day after day by parents, that forces a role shift. For you see, once you accept the reality that your child is too young, too immature, and too inexperienced to make major life decisions, then you, the parent, must step up and assume the mantle of protector.

It is in this role, as your child’s protector, that the following developmental dilemmas will cross your parenting desk:

1. Your 15-year-old daughter has a steady boyfriend. Should you insist she take birth control?

2. Your son is failing in school. Should you change schools?

3. Your 17-year-old daughter has suddenly become moody, hostile and secretive. Should you give her a home drug test, or invade her privacy and read her diary?

As difficult as these three situations are, they pale when compared to this: Your daughter has just been diagnosed with a severe psychiatric illness, and the recommendation is made that she start a psychiatric medication. What do you do?

The purpose of today’s article is to give parents basic guidelines about the use of psychiatric medications for children and adolescents.

1. When a child struggles with a problem which disrupts their thinking, feeling or behaviors, the first step toward helping them is a diagnostic evaluation. The goal of the evaluation is to answer the question, “What is the cause of my child’s problem?” The accurate identification of your child’s psychiatric problem will lead to the next question, “How best can my child be helped?” In my opinion, the most difficult part of helping children is obtaining an accurate diagnosis. Unlike adults, who can openly discuss their lives, children are unable to identify why they are struggling. For this reason, the psychiatric evaluation of children must involve obtaining data from multiple sources: parents, teachers, babysitters, as well as school and health records. When comprehensive data about your child’s development is combined with the results of specific psychological tests, a clearer diagnostic picture emerges.

2. After your child’s evaluation has identified the cause of their problem, the selection of a treatment is done. Since most children who are diagnosed with a psychiatric illness do not require psychiatric medication, parents need to become familiar with the newest generation of behavioral treatments (behavioral treatments involve teaching skills so children can learn how to overcome emotional problems).

3. If your child is diagnosed with a psychiatric condition that is severely disabling, carries a risk of self-harm, or is of known genetic/biological origins, then PM’s are often recommended. These disorders include: Attention Deficit Disorders, Bipolar, Schizophrenia, Clinical Depression, Anxiety Disorders, Autism.

4. PM’s are to be used as part of a larger and more comprehensive treatment plan, not as the sole treatment modality.

5. When the decision is made to start a PM for your child (the entry plan), there must also be a plan to discontinue the medication (the exit plan). The usual recommendation is that children who take PM’s should have a second evaluation done, within 6 months to 1 year, to ask the question, “Does your child still need the medication?”.

6. Parents play a crucial role by observing medication effects, side effects and by making sure the PM is taken, as prescribed, by their child.

7. The last recommendation is best understood by a story. Michael, 10, is diagnosed and treated for a severe psychiatric illness. His treatment is broad and comprehensive: family counseling, school support, PM’s. He improves — grades go up, anger goes down, a smile takes up residence on his face. But, when asked, “How did you get better?” He says, “The meds did it.” His wise parents respond, “Michael, the medicine you take is a pill, not a skill. Who decided to study harder? Who worked so hard to learn the skills to stop your anger? You, Michael.”

Parents make good decisions about how to help their children through a process of educating themselves, selecting professionals they can trust, and by doing the daily work of helping their children recover from a psychiatric illness. The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.

Sources: Child Clinical Psychopharmacology, Green, 2001.

 

Dr. Richard Elghammer contributes his column each week to the Journal Review.

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