Today’s post examining the pros and cons of psychotropic medication in kids is the second in a week-long series about psychiatric and learning disorders in children as part of “Speak Up for Kids,” a nationwide education campaign during National Children’s Mental Health Awareness Week (May 1-7, 2011). Yesterday, we looked at possible causes of the current epidemic of mental illness among kids in the U.S. Tomorrow, we’ll look at the struggles families face in trying to obtain the best possible treatment for their children.
The widespread use of medication among children with mental health disorders is the ultimate “hot-button” topic in our field today. Undeniably, the use of such medications in kids has increased dramatically over the last twenty years. During our series on ADHD and spiritual development, we noted that 9% of U.S. kids between the ages of 5-17 have received at least one prescription for ADHD in their lifetimes. A recent study reported that the second, third and fourth most commonly prescribed classes of medications for children (behind asthma medication) are ADHD medications, antidepressants and antipsychotics, respectively.
The question that parents ultimately face is not so much whether doctors are too quick to prescribe medication in general, but whether medication is necessary and appropriate for their child.
Today, I’d like to share three excellent resources offered by the American Academy of Child and Adolescent Psychiatry (AACAP) as part of the Academy’s “Facts for Families” series. These articles review how medications are used for children, the types of medication used and questions parents and kids should ask their physician prior to taking medication.
I could write a book on the specifics of how these medications work, but that would be beyond the scope of this post. Instead, here are some general principles for ministry leaders and parents to consider when the topic comes up:
Medication shouldn’t be prescribed until the child has had a thorough evaluation by an appropriately-trained professional with experience in diagnosing and treating children and adolescents. You want to make sure that the physician you’re working with has taken the time to understand your child and consider all of the biological, psychological, family systems, educational, developmental and environmental factors that may be contributing to your child’s difficulties. For me, the process usually takes at least three hours and involves separate interviews with the parent and the child, review of school records, and collection of observations from parents, teachers, and when appropriate, observations from other significant adults.
When non-medical treatment interventions have been demonstrated to be at least equally effective to medication and the child is not experiencing severe functional impairment, consider non-medical approaches first. A good example of this principle would involve kids with mild to moderate anxiety symptoms or mild to moderate depression without suicidal thoughts or plans. We have reasonable studies demonstrating cognitive-behavioral therapy to be an effective alternative to medication in kids with anxiety or depression.
Consider medications that have been studied extensively in kids first prior to using newer medications not yet approved for marketing in children by the FDA. In the case of kids with ADHD, this isn’t a major concern. The first placebo-controlled trial of medication for ADHD (Benzedrine…a product very similar in chemical composition to the medication currently marketed as Adderall) was published in 1937. We have over 2,000 published clinical studies or research reports examining the safety and effectiveness of ADHD medication. Prozac and Lexapro are approved for use in adolescents with depression. Zoloft and Luvox are approved for children with anxiety and/or Obsessive-Compulsive Disorder. Risperdal, Seroquel and Abilify are approved for use in kids with bipolar disorder. We’ve progressed to the point where we have reasonable clinical data supporting the use of medication for most significant mental disorders in kids. Note: FDA approval regulates what a drug company can say in marketing a given medication, but doesn’t restrict how a physician may prescribe medication. Your physician may have a good reason for prescribing medication that’s not formally FDA-approved in kids, but this is a far less frequent occurrence now compared to five years ago.
Always make sure that you understand why a specific medication is being prescribed and what the intended benefits are of the medication. We were doing a study looking at the safety of antipsychotic medications a number of years ago and I was blown away by the number of kids who came into our clinic who were experiencing serious side effects from medication that they (or their parents) didn’t know why they were taking.
Speak to your physician about discontinuing medication when your child’s not getting better. Medication for one condition can often result in exacerbation of other conditions. In my practice, we probably stop more medication than we start. When things aren’t working, we often thoughtfully discontinue medication in order to reestablish “baseline.” Note to parents…Speak to your child’s physician first before discontinuing any medication on your own!
Bottom line…Medication in the hands of an appropriately trained physician can be one instrument God uses in responding to prayers for a child with a serious emotional or behavioral disorder. In the same way, God may use a physician who’s not necessarily a Christian to bring about healing…Christians in my field are only slightly more common than victory parades in Downtown Cleveland. God’s not limited to using Christians to help kids with issues.
Today’s Featured Resource: ParentsMedGuide.org. The American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry have developed two medication guides, ADHD Parents Medication Guide, and The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families. These guides are designed to help patients, families, and physicians make informed decisions about obtaining and administering the most appropriate care for a child with ADHD or depression. The guides have been endorsed by many national medical, family and patient advocacy organizations. In addition, AACAP has developed theMedication Guide for Treating Bipolar Disorder in Children and Adolescents, which has been approved by the APA.