To Medicate or Not to Medicate?

fruit by the footThis is a big question that often comes up when I’m consulting with parents about their kids:  should they be on medications?  Firstly, let me say that as a psychologist, I do not prescribe meds and this is not my area of expertise.  However, I do work closely with psychiatrists to coordinate the psychotherapy aspects of treatment, and I can speak to the dilemma that many parents face on this issue.

There are a lot of mixed messages floating around these days with regard to medications.  On the one hand I commonly hear the sentiment that kids are over-medicated, and that many kids who don’t really need meds are on them.  On the other hand I often hear the sentiment that the right kid on the right medication benefits tremendously in certain cases.  Most of what I hear, however, is that it’s a mixed bag where positive effects are sometimes found, and sometimes seem to ebb away again, while side-effects sometimes seem either a necessary evil, or in some cases a disaster worse than the original problem.

So, what’s a parent to do?  A good place to start is by conceptualizing your child’s well-being as the center of a team of people (not necessarily shrinks and specialists, but rather family, teachers, coaches and friends).  When issues arise, such as attention-difficulties, struggles with learning, impaired social relatedness, depression or anxiety it serves a child to be seen in an entire context.  What do teachers report at school?  What you you observe at home?  How much is situational, how much is inherent to the child?  Thus before we can intelligently decide the best course of action, a thorough understanding of what’s actually the matter is in order.

Problems are multi-determined, therefore behavioral issues in a kid might reflect a combination of nature and nurture.  For this reason a good first line of response is for parents to take their own inventory:  is there strife in the house?  Are there stressors such as money worries, losses, illness or life changes such as moving that contribute to a child’s anxiety or otherwise impede their functioning?  If parents can be truly at their best (sober, in therapy if needed, able to manage anger), we have a much clearer picture of what is more purely a child’s innate struggle.

Next, a thorough evaluation of the entire child is highly useful.  The first step there is the pediatrician; many conditions that might appear psychological could have a biological basis, and a clean bill of health is important to establish before meeting with a child psychiatrist.  Additionally, an evaluation of cognitive and emotional functioning can be requested, at no personal expense (you’ve already paid for it with your taxes) by requesting an evaluation from your local public school.  Funds are always tight and this service is not generally broadcast, which is why I mention it here.  For more on this see a prior post about IEPs (individual education plans— http://tiny.cc/MGRnG ).

Keep an open mind.  If your team of helpers ends up suggesting a medications consult (and that is all anyone who is not a psychiatrist or specialist trained in medications really ought to say), you then must search not just for a psychiatrist, but for one who you feel you can talk to, trust and work with.  Friends who say they have worked with a given psychiatrist and had a good experience is an excellent place to start.  And call sooner than later—it often takes quite awhile to get an appointment, which can be frustrating, but also speaks to the strong demand for such services (in other words, you are not alone).  Once you’ve gathered several names, call them all and see how each one strikes you.  Things like this are partly about a match, and not just a reputation.  You should feel free to ask questions and expect mutual respect and a team effort around your child, and not just an expert who is never to be questioned.  And remember, it is possible that you may consult with a psychiatrist and determine that medications are either not needed, or optional and a wait-and-see approach supplemented by other interventions can be tried.  Different psychiatrists are at different places with alternative approaches, but I know of one recently who suggested fish oil for attention issues, given that the science is showing up in favor of it.  In other cases a psychiatrist may feel that medications are essential to help a child, or keep a child out of harm or further deterioration; keep in mind that sometimes progress can be measured in things simply not getting worse, if they had been in steady decline.

An important thing to keep in mind is respect for different attitudes and approaches.  I would say that roughly half of the clients I see end up taking medications and half either don’t need them or choose not to take them.  There is evidence, for example, that mindfulness practices such as yoga or meditation are valid interventions for a range of conditions including depression and anxiety.  If a family works together and comes to a unified decision, a child is in better shape than if the parents are at war about either position.  Also, we are best off respecting other families rather than judging them.  It is a very personal and complex decision to medicate a child, and no one is ever thrilled to need to even consider it.  While people may say flip comments to the effect that we’re just medicating kids because we don’t want to deal with them, I can’t say that I’ve ever met a parent for whom this was actually the case.  Parents love their kids and want the best for them.  More education on issues, from ADD to bi-polar, might enhance greater compassion and a kinder culture, and while this might sound unrealistic, our culture is the net effect of all of us, so anyone who chooses less judgment and more compassion could well be benefitting all our collective children.

A few final comments on medications include what’s called a “drug plateau” in which we see a benefit, but it levels off and doesn’t take a person, child or adult, all the way to well-being.  This is where things like yoga, therapy, nutrition and self-esteem enhancing activities must also be employed—and as mentioned above—where parents taking good care of themselves, physically and psychologically, contributes to the well-being of children.  Ultimately, the question of what to do, be it medications, changing schools, trying a homeopath or eastern medicine approach, etc. distills down to the how of going about it; right attitude in many cases is right action.  After all, a child may “have” a diagnosis, but they are never to be defined by that label; all children (and everyone else as well) are sacred beings, and we all have our areas of challenge or limitation.  Sometimes we have to deal with reality, such as an unhappy and over-stressed culture, and in turn do what we must to help kids adjust to a world that, in actuality, needs the adjusting.

While a blog such as this cannot possibly tell you what is best for your child, it can encourage you to take a deep breath, not turn away from whatever the problem is, gather all the information that you can and then make the best informed and loving decision that you can—and then monitor from there; we try things, see the result, try a different thing.  In the end, we don’t need to be right so much as effective.  Beyond that, this blog perhaps can also offer a little human compassion and understanding for just how scary and uncertain, not to mention heart-breaking, it can be when our kids are struggling and unhappy.  So today, maybe we can send a good thought into the ether for all parents and children who are struggling to find the right approach to whatever ails them, challenges or discourages them, or seems to impede their family’s growth and happiness.

Namaste, Bruce

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3 Responses to “To Medicate or Not to Medicate?”

  1. A.N. Says:

    Thank you Bruce for being so brave in offering the place where parents can gather safely arround tricky or light subjects equally.
    Hopefully your amazingly informative and very compationate ways around this issue will find their way to a right parents heart and dispel the fear and most of the scariness that comes with it that makes us act in ignorant and abrupt ways–oposite of where we need to make decisions from especialy about our children. …

    As a mother and as a mother of a child with special needs it is very clear to me that if you parent in a light of consciousness and you spend time with your child interested, questioning and really knowing what is happening with them most of the time, there is also an invisible aid that never fails us as mothers- called intuition that will always be there for us. My mind said many times that I was out of my mind in “seeing” something (and everybody else wide around me)- and my mind was right: I was out of my mind and in my heart, making INFORMED decisions out of my heart’s mind!

    Our daughter was coming back from school for couple of weeks and was getting very impatient and angry at home with all of us and was acting out peeing herself (she is almost 8 yo) , bursting into tears quickly out of frustration and we even found her walking on a friend’s guest house roof ledge!! not wider than 5 inches with a 20 feet drop down onto the concrete on both sides-we were very lucky she didn’t fall!! Our son got us and brought us to her (we thought she was with her girlfriends in the other room playing).
    It looked to me like a major cry for help and I had a very deep conversation with her the next day where she said that her shadow person is angry all the time with her! And showed me with her stiffened little fists and teeth how that anger looked to her.
    We had an emergency meeting with both principles and stopped all the “chill out” time outs and anything that would resamble any kind of unkind, dis-empowering ways with my daughter at school. We sat a program up where she would do her cognitive program of reading and math with her best girlfriends for an hour (instead of her shadow), as a transition. We also put in place the first hour of school for her to be arts and crafts in the classroom because math just doesn’t work for her first thing in the morning.

    We had another meeting 4 days later and by introducing the new things, her shadow was in total opposition of it all, and clearly frustrated to how little “power” she would have over my daughter. It was obvious she was not on our team any longer and she has lost her ways even in a face of situations with principals around. They found out she was disciplining my daughter with anger and frustration and timing her out for not wanting to go to the bathroom! or not wanting her snack or saying no to her friend!

    I know this sounds like a monster person, but she is really academically brilliant,very sweet most of the time and she was crucial in forging our daughter forward cognitivlly the last year. She also LOVES our daughter, but just did not have means of not letting her own stuff come in the way between them. She is very overloaded in her own life and in a very shaky relationship…..all the things that should not be leaked to a small child with special needs (or any child at all) that has planty of frustrations on their own of ideas being locked inside of them and inability to express them verbally…etc, however, obviously, these things do leak….. and in my daughter’s case-literally.

    We also came up with an idea called TIME IN instead of TIME OUT where she is given her own little space at school, where in moments of frustration, anger or tiredness she can draw, paint, make words in her journal, make crafts, squash or tear paper…..or just rest for a bit–the idea is to give her an opportunity to express her feelings in a way that is closest and most natural to her at home and everywhere-the way of the art-and that would be empowering for her. Needless to say she does not work with that shadow any longer and so far hasen’t peed herself, or acted inappropriately out of anger once since!

    For a moment when things were escalating and getting very scary, it did cross my mind that her behavior will bring us to an extreme depression in the teenage years and this was just a beginning, and she will become less and less happy and than the sickness will take over because of it, and she will die! It did cross my mind when watching her unhappy and unable to get through to her to take her to a doctor, or psychiatrist or both with a possibility of medicating her….
    But by now, I know that the nature of mind is to create negative scenarios around fear and it’s up to us to catch it for the benefit of our children, and dare to really really “see”, find out, discover, or stumble upon the true nature of things and act only once that this is in place. Our little ones, with their constant “gifts” in a form of a new or scary issues are helping us to grow, rise to the occasion and deepen our knowing them and self-knowing, and ultimately deepen our relationships.

    Thank you and Namaste!

  2. krk Says:

    Thank you,Bruce,for your compassion and sensitivity to a challenging problem.

    Thank you,A.N. for your generous sharing.

    krk

  3. A.N. Says:

    Thank you Krk for the appreciation and a big hug and thank you for shouting BRAVO way back at the IEP station-it made me so happy to see your comment!

    By the way krk is an island in my country where I used to spend summers with my parents…..

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