Understanding when to medicate for childhood disorders
Will medicine fix my child? As a therapist, one of the most common questions I get asked is how to know when to medicate a child for behavioral or psychological disorders. There are several red flags for when it is time to make that appointment.
Will medicine fix my child? As a therapist, one of the most common questions I get asked is how to know when to medicate a child for behavioral or psychological disorders. Ideally, medication gives the child a "buffer" in which they have more time and flexibility to think about their experience or feelings, enough to utilize coping skills to better choose how to respond or express themselves in healthy and safe ways. Medication may help with things like hyperactivity, difficulty sleeping, irritability, tics or aggression. When the right medication fit is found for the child, and it is taken as prescribed, some benefits may be noticed: moods a little more level, a fuse that lasts a little longer, or a buffer of time increased enough to ask for help. The child may be able to focus a little better or a little longer, stay on task a little more consistently, or be a little more willing to cooperate.
I always have to refer people to their doctor or a psychiatrist to discuss medication issues, but there are several red flags for when it is time to make that appointment.
Loss of functioning
Sometimes parents or teachers want a child on medication because either the child or the people around the child are not functioning as they should (or both.) When a teacher recommends a medication referral for a wiggly or disruptive child, it is important to look at how the child is functioning in class. Is the child progressing well in school, even if the child is not sitting still? Or is the child falling behind because they cannot focus, pay attention or complete tasks? How much of a disruption is the child to the learning of the other students? Is the class itself still functioning? Whether a parent decides to medicate or not, there are many helpful tips for an active child in the classroom. When a parent asks about depression medication referrals, functioning questions are also important. Is the child just tearful? Or is the child not getting out of bed at all — ever? Is the child unusually sad? Or also not completing hygiene, skipping favorite activities and hiding from friends? The National Institute of Mental Health has a great FAQ for parents and teachers of depressed high school students.
Sometimes the need for a medication referral is more obvious. If a child is seeing or hearing things that are not there, especially if this prompts aggression toward self or others, then definitely call the doctor right away. Mania that causes impulsive or out of control behavior, especially if it is dangerous (such as a teenager's reckless driving or sexually acting out), may be a good cause for a referral. Extreme issues with self-perception that cause changes in eating or exercise behaviors may indicate an eating disorder, which can require hospitalization. Sometimes simple things, like not sleeping or a urinary tract infection can cause a loss of touch with reality as well.
Loss of Control
When a child is already in therapy but continues to struggle with safety issues or aggression towards self or others, a medication referral might be needed. When a child is so anxious they cannot breathe or stop crying enough to talk, medication might help. Other loss of control issues, like bedwetting or soiling pants, could have other causes that need to be assessed by a medical doctor.
Loss of Hope
Hope is how people progress even through challenges and difficult experiences. When a child is not responding to therapy, symptoms escalate or it seems everything else has been tried, it is definitely a good time to check in with the medical doctor. Whether to rule out organic causes or to discuss medication options, a doctor can help restore hope to the child and the family.
Remember that medications are intended to rebalance chemicals in the brain, not target specific behavior problems. Medication will work differently in each child and often require a trial and error period in addition to the two months most medications need to start taking effect. Some diagnoses, like anxiety or depression, can sometimes benefit from medical intervention while others like Oppositional Defiant Disorder or Reactive Attachment Disorder are not necessarily caused by medical problems and so may not always benefit from medical treatment. Other diagnoses, like the BiPolar Disorders or Schizophrenia may demonstrate such a benefit from medication that the person is actually less likely to continue taking medication as prescribed (because they "feel better"), causing "relapses" that make them more sick each time they stop treatment. Many medications have side effects than can be really scary or even alter the child's personality.
Medicine does not "cure" a child's behavior, nor does it undo past experiences or correct family dynamics that may be contributing to current behaviors. Medicine does not replace therapy, help a child practice following directions, learn more quickly or increase communication skills. In addition, a child on too much medication or taking medication that isn't needed will not be able to function properly enough to practice problem-solving or expression skills. If the child is so sleepy, lethargic, or flat that they cannot interact well with others, express themselves, or accomplish simple tasks, then it is still not a positive benefit even if some negative behaviors are reduced. It is important to discuss medication choices with a medical doctor and take medications as prescribed (including not stopping them suddenly without first talking to the doctor.) Research alternative options, and discuss those with your doctor as well.