Read an Excerpt
Chapter One
PART I
What Every Parent Should Know
about Psychiatric Medications
for Children
When your child has a psychiatric problem for which medication may be prescribed, a thousand questions beg to be answered. Parents come to me with an urgently felt need for information--and often more than a little anxiety as well. In this section, I've compiled the questions that usually come up--in my office as well as at the talks I give about four times a month for professional and parent support groups across the United States, the United Kingdom, and Europe--with the most current, most complete answers that can be given in a book meant to speak to a broad cross-section of parents.
As is stressed throughout the book, you are a key player in your child's mental health care. To fill that role optimally, you need to stay as well informed as you can about your child's problem and the treatments available for it. This involves asking the right questions as well as getting reliable answers. I hope the following questions, posed by hundreds of caring, concerned parents before you, will get you thinking as a proactive collaborator in the care of your child. And I hope the answers will give you some of the comfort and reassurance that knowledge provides. Always remember, though, that your child's situation is unique. The right answers for your son or daughter will always come mainly from the cooperative efforts of you and the qualified professionals you have chosen to care for your child.
The following questions and answers have been divided into four groups, based on when in the diagnosis and treatment process they usually arise. Questions asked by parents who are just considering seeking help for their child come first. Next are questions and answers for those currently involved in the evaluation process. The third section addresses questions about the diagnosis and the treatment proposal that emerge from the evaluation. The last section addresses issues that come up when a child is already being treated with medications for a psychiatric or psychological disorder. Read all of Part I for an overview or turn to the individual sections and questions within them as needed. Either way, I hope you will find what you need to know. If not, please ask your child's practitioners--that's what they are there for.
THE PRELIMINARIES
Building a Foundation of Knowledge
It is never easy to face the fact that your child may need help for a mental, emotional, or behavioral problem. A tough situation becomes harder when, like most parents, you know little about the subject of childhood psychiatric disorders and their treatment. It gets even more difficult when you're plagued by the misconceptions and myths that abound.
Perhaps you've just consulted your child's pediatrician because your son or daughter has been behaving differently, and the doctor has told you that he or she suspects a certain disorder is present for which medication is usually the recommended treatment. Or you may be wondering if medication could help your child now that a longstanding problem is worsening and no longer manageable by other means. Maybe you're just beginning to believe something might be wrong with your child, and what you've read about similar problems has left you confused and a little alarmed. You're not alone. More and more people--parents and professionals alike--are becoming aware that medication is a viable option for treating many psychiatric problems in children, but the field is new enough to leave numerous gaps in our collective understanding. At this preliminary point, parents want to know everything from "Why is medication necessary?" and "Isn't there any other treatment?" to "What will happen if we just wait and watch?" and "How do we know drugs designated for this purpose are safe?" If you are at this stage with your child, the following background should help you decide whether to go ahead and have your child evaluated for possible medical treatment.
What makes the doctor think my child needs medication?
There is no simple answer to why any child may need medications for a psychiatric or psychological problem. Each child's situation is unique, complex, and constantly evolving. Any decision regarding the child's care and treatment should be the result of a thorough evaluation of the many factors involved and a thoughtful consideration of all the alternative solutions available. As I hope to reinforce throughout this book, however, you have an absolute right to seek a satisfactory explanation for any decision about your child's case from the doctor who has made that decision. Never be afraid to ask. You should have a good grasp of the conclusions your child's doctor has reached and the rationale that led the doctor to the recommendation before your child embarks on any form of treatment. In fact the entire evaluation, diagnosis, and treatment process should be a collaborative effort between you and your child's health care providers. To broach the subject with your child's doctor, try saying something like "I'm trying to understand your decision-making process. Can you walk me through it?"
Whether your child needs medication depends on the problem, its causes, and its effects on your child's life. Some mental and emotional disturbances simply don't respond to what we call the "talking therapies." Others are treated most successfully with a combination of psychotherapy and pharmacology. Typically, a doctor may consider medication based on the belief that the child's problem has a medical cause, or etiology (it's not just "all in the kid's head"), especially one that usually worsens with time or with stresses in the child's life. In cases like this, the child may seem perfectly healthy physically even though the cause of the problem originates in the body. Such medical conditions are frequently unlikely to go away on their own, and the child's symptoms may very well get worse if ignored. Many of the childhood psychiatric conditions for which medication has been used over the last decade fit this description. Attention-deficit/hyperactivity disorder (ADHD) is one example that many parents have read about. Scientists now believe that the impulsivity, short attention span, and other symptoms associated with ADHD are caused by a specific dysfunction in the brain that often is inherited. How severely impaired the child is by the ADHD, however, depends on the severity of the ADHD and on environmental factors such as whether the child's parents and teachers take the child's disability into account in rearing and educating the child. A child whose disability is ignored is likely to suffer academically and socially. In turn, these experiences tend to aggravate the symptoms of ADHD and may even spawn additional problems, such as defiant, destructive behavior. So, if your child's condition is causing even moderate distress and is pervasive, the doctor may have good reason to consider medication management.
dysfunction: The state of not working properly.<
