How would I know if my child would benefit from medication?

PillsWelcome to the second installment in our Summer 2013 blog series…Ten Questions Parents and Caregivers Ask About Kids and Medication. Today, we’ll examine the question How would I know if my child would benefit from medication?

Given all the controversy generated by the topic of psychiatric medication for kids and teens, I’m frequently asked for guidance and direction from parents and caregivers as to when medication is necessary and appropriate. Here are some clarifying questions I share with parents to help them in their decision making process…

Does your child have a mental health condition for which medication is demonstrably effective? Just because a child has a mental health condition, that doesn’t necessarily imply that medication will help…or help more than other interventions. Some examples of conditions for which medication is demonstrably effective in kids:

  • ADHD
  • Anxiety Disorders
  • Obsessive-Compulsive Disorder
  • Aggressive behavior in kids with autism spectrum disorder
  • Bipolar Disorder (accurately diagnosed)
  • Schizophrenia
  • Depression (modest effect)

Does your child’s condition result in significant functional impairment in one or more major life domains (school, friends, family, community)? A fairly frequent scenario I’ll encounter in my office is a kid suspected with ADHD who meets the diagnostic criteria in terms of having enough symptoms but continues to do well in school because of high intelligence or use of compensatory strategies, and has little difficulty with family or peer relationships. A general rule of thumb is that we don’t treat the disorder…we treat functional impairment or some maladaptive trait associated with the disorder.

Your child has a condition for which evidence-based non-medical treatment is unavailable, has been unsuccessful or less effective than medical treatment. Let’s use the example of a child with panic attacks and social anxiety who is 15 sessions into a course of cognitive-behavioral therapy (CBT) from an appropriately trained therapist who has demonstrated little improvement. Let’s say the child lives in a community where regular CBT is unavailable. Medication for anxiety would certainly be appropriate in either of those situations. Here’s another example…let’s say we’re treating a teen with ADHD who struggles greatly with organization, focus, work completion and academic performance. Behavioral interventions are more likely to be successful after an effective medication regimen is established for ADHD.

Does the severity of your child’s condition require a more rapid response than available through non-medical treatment? If we have a kid come in with severe depression, accompanied by significant suicidal thinking, we’d be more likely to consider starting a trial of medication together with CBT. Or say we have a child with an autism spectrum disorder who can benefit from applied behavior analysis (ABA) who becomes so aggressive during transitions at home that the safety of other children in the home is placed at risk? Medication to reduce the risk of aggressive behavior while behavioral interventions are put in place is certainly justified when reducing or eliminating the behavior is necessary if the child is to continue to live at home.

Photo courtesy of http://www.freedigitalphotos.net

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600817_10200479396001791_905419060_nConfused about all the changes in diagnostic terminology for kids with mental heath disorders? Key Ministry has a resource page summarizing our recent blog series examining the impact of the DSM-5 on kids with mental health disorders. Click this link for summary articles describing the changes in diagnostic criteria for conditions common among children and teens, along with links to other helpful resources!

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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