Medication

Recalculating Part II: Considering Medication

The suggestion to put your child on medication may bring an automatic “No way!” to your mind. After all, haven’t we all sat through TV ads about drugs that, judging by the actor’s beatific expression, seem to be miracle cures? And then haven’t we all felt the skepticism creep in as the announcer’s voice speeds up and reels off a series of unpleasant, and even life-threatening, side effects?

Most parents are very hesitant to put a child on medication, but there are some factors that might combine to make it a useful option. For instance, in some cases a child’s anxiety limits his ability to go to school, participate in sports or other activities, or participate in therapy that is designed to help him learn to tolerate anxious feelings. Sometimes, the child’s behavior can be seriously disruptive to family life, or even threaten the child’s health, such as when a fear of choking makes him reluctant to eat. I have been involved in cases, such as ones dealing with a child with school anxiety, in which there has been very good collaboration between the school, home and treatment professionals , and it is still not enough because the child is just too distressed and anxious to participate on her own behalf. In these cases, and in others, such as obsessive compulsive disorder, medication has often been quite helpful. Medication can help turn down the volume or intensity of the anxiety so that the hard work of learning coping skills becomes more obtainable.  So yes, medication can be helpful. And we need to stop and ask ourselves whether we have made a good faith effort to explore behavioral intervention, pausing to make sure that the treatment has been appropriate to the problem,  and then  can honestly say to ourselves “These reasonable efforts aren’t enough”.  Of course defining “enough” involves calculating a number of factors that are not always easy to define.  

Deciding to use medication is similar to the decision-making process for any intervention: It involves sorting out the “risk-benefit ratio.” In other words, are the potential benefits worth the potential risks? Additional, we need to ask of the possible interventions which ones are likely to be effective for the problem at hand. For your own thinking and also to get the best possible advice from any professional you may consult, it is important to clearly describe the problem and it’s history.   A behavior checksheet can assist in this process but it cannot replace your own observations. . A concisely summarized, one-page report from a parent can help a professional give more effective help — and of course, the parent must feel that the professional is trustworthy. A good professional has the attitude of Jerome Groopman in his book, How Doctors Think. In his conclusion, he states, “But after writing this book, I realized that I can have another vital partner who helps my thinking, a partner who may, with a few pertinent and focused questions, protect me from the cascade of cognitive pitfalls that cause misguided care” (p 268-269).  I would hope that you have a physician for your child with such a perspective. In the best of circumstances a decision to consider using medication involves a careful weighing of options and creation of collaborative relationship with the professionals involved.