Doctors and parents should consider having a long and thoughtful discussion before medicating a child for A.D.H.D., anxiety or depression.
Whenever I write about children getting medications for anxiety, for depression, or especially for attention deficit hyperactivity disorder, a certain number of readers respond with anger and suspicion, accusing me of being part of a conspiracy to medicate children for behaviors that are either part of the normal range of childhood or else the direct result of bad schools, bad environments or bad parenting.
Others suggest that doctors who prescribe such medications are in the corrupt grip of the drug companies. And there are parents with stories of unexpected side effects and doctors who didn’t listen. (Of course, there are also parents who write to say that the right medication at the right moment really helped, or adults regretting that no one offered them something that might have helped back when they were struggling.)
Putting children, especially young children, on psychotropic medications is scary for parents, sometimes scary for children and also, often, scary for the doctors who do the prescribing. As a pediatrician, I have often had occasion to be grateful to colleagues with more experience and training who could help a family figure out the right medication, dosing and follow-up.
It is a big deal, and there are side effects to worry about and doctors should listen to families’ concerns. But when a child is suffering and struggling, families need help, and medications are often part of the discussion. And so, without presuming to judge what should be done for any specific child, I want to talk about the discussion that needs to take place around medicating a child in distress, and how the doctor and the family should monitor medications when they are prescribed.
Parents worry that medications will affect their children’s personalities, said Dr. Doris Greenberg, a developmental pediatrician in Savannah, Ga., who is associate clinical professor of pediatrics at Mercer University School of Medicine. She can see the message in their faces: “my child has a spirit and a sparkle, and we don’t want this taken away.” She faces this directly: “I ask them, what are you worried about, what horror stories have you heard?”
The family probably has been dealing with a very symptomatic child for a while before they get to her, and “when they come in, they’re kind of wounded.” Before talking about medication, she said, it’s important to understand — and to be sure the family understands — how the diagnosis is being made, and why medicine is even being considered. “We don’t treat people who aren’t impaired — just because the kid wiggles,” she said.
Dr. Timothy Wilens, the chief of the division of child and adolescent psychiatry at Massachusetts General Hospital, said, “The issue of medicine itself stamps that your kid has a behavioral health issue — they have a disorder that’s requiring treatment.” Dr. Wilens, the author of the standard recommended book on psychiatric medications for children, has faced criticism in the past about ties to pharmaceutical companies; he regards it as an academic obligation to work with the industry, he said, and discloses that directly to parents.
Dr. Wilens said that at that first visit, it’s especially important to discuss the diagnosis with parents, and be sure that they are in agreement about what the problem is. “I stop and say to the parents, Is this what you’re seeing? Does this make sense to you?” he said. “And I talk to the kid. This is what I think it is, does this feel like this is what you have?”
Medication isn’t always appropriate. For anxiety, he said, “I’m probably not going to recommend you go right on medication, I’m going to talk to you about cognitive behavioral therapy.”
|Read on: When Medicines Affect a Child’s Mind and Behavior – The New York Times|