It’s safe to assume that no parent wants to put their child on psychiatric drugs. But fearing pharmaceuticals isn’t necessarily a plan either. You want to take a measured approach, evaluate all the options, and make sure your doctor doesn’t dole out meds like Pez.
It can be hard to interpret the psych-speak, but Dr. Joyce Nolan Harrison, Assistant Professor at Johns Hopkins University School of Medicine and a staff psychiatrist at the Kennedy Krieger Institute, stresses that while feeding your kid pills shouldn’t be the first solution, there are some instances where it might be the best course of action. Here are her thoughts on the most common psychiatric conditions she sees in young children, and what to expect with treatment.
Know Your DSM
If your doctor is worth their M.D., they’re not going to slap your kid with a diagnosis after just one visit. The first step is determining if their behavior is even a psychiatric issue using the APA’s Diagnostic and Statistical Manual of Mental Disorders (or DSM). “The first step when we’re thinking about medication is making sure we’ve done a really good assessment and we aren’t dealing with some kind of developmental disorder or communication disorder or medical disorder that wouldn’t warrant a psychiatric medication,” explains Dr. Harrison. In other words, if you walk into the office and declare that your kid has ADHD, they’re not just going to take your word for it and start filling out a prescription.
Attention Deficit Hyperactivity Disorder is one of the most common reasons for a kid under 5 to go on medication, but it’s not the only one doctors see. Young kids can have all sorts of anxiety disorders, particularly separation anxiety — the more paralyzing version of that tantrum they throw at school drop off. If they’ve experienced some sort of trauma (real trauma, not “time out” trauma), they might even develop symptoms of PTSD. And, if you’re still waiting on those first words (with fingers crossed for “da-da”) or you notice they’re shockingly silent in school versus at home, it could be Selective Mutism.
You’re Going To Be The Medical Assistant
Sometimes the diagnosis is a severe case of being a kid. Your doctor will need to do a series of evaluations. With young children, you can expect a lot of their questions to be directed at you. “A lot of parents don’t know what happens in a psychiatric visit. They think they just drop off their kid, and we figure out what’s wrong,” says Dr. Harrison. “Very often the parent will be in the room the whole time, and we’ll try to get information from the parent as we observe the child.” Follow-up appointments might be necessary to get a better picture, and they might even ask for additional info from their school or daycare provider.
“A lot of parents don’t know what happens in a psychiatric visit. They think they just drop off their kid, and we figure out what’s wrong.”
The Step Before Medication
Once your kid gets a diagnosis, your doctor still won’t just shove a prescription in your hands and send you on your way. The next step is to try non-medication intervention with behavior management. And not for them — for you. Sometimes it’s just about adjusting your parenting style to learn things like reinforcing positive behavior, giving simpler instructions, providing more structured routines, and removing distractions in school. “Sometimes, biologically, they just can’t do it. But you have to try some of these other interventions before you jump to medicine,” says Dr. Harrison.
When It’s Time To Fill The Prescription
If your kid has such severe separation anxiety that their nerves are making them try to jump out of the car on the way to school, the problem might be beyond what you can do with behavioral management (and child safety locks) alone. “If you have a child whose function is really impaired and it’s really clear that the psychiatric disorder is the source, and you’ve tried other interventions and you’re still having considerable functional impairment, that’s where we start thinking about introducing a little bit of medicine,” explains Dr. Harrison. Ready to go full Mary Poppins?
Facts About Stimulants
“Of the 3-to-5-year-olds that I treat [for ADHD], probably close to 70 percent of those that we medicate get a stimulant,” says Dr. Harrison. That’s a drug like Ritalin. Yes, Ritalin — it gets a bad rap, but there’s a ton of research on the efficacy and safety of the drug, and stimulants directly address issues of attention, impulsivity, and hyperactivity while your kid takes it. “About 90 percent of kids who truly have ADHD have a good response to stimulants, and don’t have problematic side effects when [the dosing] is done carefully. They’re effective and they’re well-tolerated,” explains Dr. Harrison. Your tolerance level is a different story.
The List of Side Effects
Make sure you’re clear with your doc about possible side effects. For instance, ADHD stimulants can affect kids’ sleep and appetites. Also, if your kid is on the small side, your doctor might prescribe a combination of a stimulant and an alpha-adrenergic agonist non-stimulant drug to help their metabolism balance it out. There are also times when your kid might experience a “rebound” when their medication wears off, where they’re experiencing more symptoms than before they started taking the drugs. And, if there’s any family history of heart conditions, your doctor will probably order an EKG before getting them started on a medication. Their blood pressure and heart rate will be monitored every time they have a check-up.
The big thing to note is that there are a lot of different medication options. If something’s not working for your kid, you can stop or change it. “The bottom line is, we weigh the side effects against the benefits,” says Dr. Harrison. At the end of the day, that’s your decision, not the doctor’s.