For every parent, the decision to medicate your child is always a challenging one. Even more so, when making the choice to medicate for a mental health condition. This may simply be because we are more familiar with treatments for physical ailments – antibiotics for tonsillitis, otitis media and pneumonia and corticosteroids for croup, juvenile arthritis and encephalitis. These antidotes have been around for longer, have more clear evidence of their efficacy and their longer-term effects are perhaps less controversial and worrisome.
Despite mental health becoming more mainstream, unfortunately the understanding of its likely causes and the options of treatment have been slower to progress and many useful medications for childhood disorders like Ritalin for ADHD, have attracted negative attention along the way; preventing some children from experiencing the remarkable benefits of its appropriate use and efficacy.
Mental health still carries immense stigma and for many people, it is taboo and considered to be a ‘weakness’ or something that you ‘just need to get over.’ A multitude of suffers (including their families, partners, friends, educators and colleagues) are barricaded by these sentiments, remaining in silent misery, which can lead to fatal consequences. Suicide is amongst the highest causes of death in teenagers.
So, what do you believe, and where do you turn when you observe someone close to you being depressed, anxious, school refusing, isolating in their bedroom or unable to sit still and concentrate enough to complete their homework? When is it a problem? Is it simply normal childhood behaviour that they will grow out of? These are extremely common – and very good – questions that parents ask their health professionals (and friends, GOOGLE and anyone who will listen) every day.
I recommend following a detailed, measured, considered and step-wise approach to treating a mental health disorder with medication:
- Diagnosis – what symptoms are present and do these meet criteria for a particular disorder? At times, not every symptom of a disorder is present but there is enough distress and a significant negative impact to justify treatment. The diagnosis should focus on the whole picture, trying to identify any contributing or aggravating factors and possible reasons for the current presentation (particularly if the problem has been there for some time). Many times, the issue has been longstanding but not as visible, which could make parents think it is something new.
- Looking at the complete picture is important because children in particular are impacted and affected by their surrounding systems. (School, friends, family etc.) All of these areas for intervention and part of a comprehensive treatment plan.
- Distress – We can all have symptoms of depression or anxiety, but it may or may be causing overwhelm and distress. It is normal to feel down when bad things happen and having some anxiety can be motivating. Try to use normal emotional responses to challenging situations as opportunities to build resilience and coping skills.
- Dis-ability (functioning) – When symptoms cause visible problems in relationships, self-care, academics and health, it is a signal that treatment is needed.
- Detailed plan – treatment should take a bio-psycho-social approach, meaning that medication, therapies of various kinds and addressing the environment are all important and should form part of the treatment plan. Medication is often needed where therapies and non-medication options have not helped, or only partially improved the problem. Be sure to involve school and other agencies involved in the child’s life into the plan. Everyone should be working together and communicating to ensure that all stakeholders are on the same page.
- Definite treatment targets – treatment should have goals and time frames. It helps to have a working hypothesis of the problem, using treatments to test the hypothesis. It can be a process of trial and error and this is because mental health disorders are a complex presentation of interacting genetics, epigenetics, environment and biology. Frequently, it can take time to uncover factors that may be impacting the child. It is not uncommon to discover unknown traumas and abuse following years of treatment.
- Decide on time-frames – all treatments should have goals and clear time frames in which to review those targets. Medications used to treat mental health take time to work and have side effects that make it best to take a slower approach, but it means that improvements may not be readily noticeable. Be careful not to make increases too quickly, but equally don’t stop medications prematurely. Some conditions (OCD) require higher doses and longer time frames to bring about improvements. All of these should be considered when evaluating benefits.
- Distress plans – ensure that you have discussed plans for moments of immense distress, or high-risk situations. These can be formulated by the treating doctor, psychologist or school counsellor.
- Dedication and expectations – Things take time and there are no quick fixes. Many issues are corrected over time and with age and growth. Different stages may require a different focus; at times it is about safety, or school attendance or symptom improvement. Have realistic and clear expectations and remain consistent with the process. Find a trusted professional who will provide the best, honest advice. Keep reviewing the plans, goals, improvements and setbacks against the hypothesis. Remain open-minded and join support groups with other parents who have had similar experiences and can share their knowledge.
- Develop and maintain open communication with your child: ask how they are feeling and if they have had a bad day, what they believe may have caused it? This can help evaluate the efficacy of the medication, particularly in the context of situational influences on your child. Using a gentle, non-confronting stance will likely encourage your child to become mindful and reflective within their day. It can become an opportunity to teach problem-solving skills and strengthen your relationship with them. Open communication and being non-judging will make your child feel more comfortable expressing their thoughts and feelings when they are struggling and ensure that they don’t hide in fear of your responses.
- Early intervention is the best approach. We know that experiences shape the brain and that stress is toxic to brain development, so it makes perfect sense to ensure that negative experiences and stress are minimised in a child whose brain is undergoing rapid growth. Medication, if used correctly, can prevent the impaired structural and functional brain development caused by traumatic and stressful experiences and the ensuing toxic effects to the brain. It is not only the presenting problem that is being treated, but you are preventing the secondary consequences of untreated illness – poor self-esteem, anxiety, self-harm, lack of trust, academic failure etc. etc.
By Dr Lisa Myers
Child and Adolescent Psychiatrist
