This month’s Best of the Best topic is on the use of medications: Have you used them with your child or considered using them? If you have used medications with your child, do they help or have they helped? Have medications been recommended but you’ve avoided them and why? Have you had a difficult time finding a qualified pediatric psychiatrist to monitor your child?
I am assuming from the last question that the focus of this topic is primarily on psychiatric medications, as this is the category most people are referring to when they say, “I would never medicate my kid,” or “The schools, or doctors, or nameless, faceless bad guys just want to over-medicate our kids!”
Frankly, I cannot really address this topic on any sort of large scale, being a parent with a non-medical background, so I am simply going to share what our own experience has been with the use of psychiatric medication for our son.
I’ve written a bit over the last few months about our own journey on this front, here, here and here, so I’m going to be referencing some of what I wrote previously as well as sharing where we are now with it.
A psychiatric medication was first suggested to me in the spring of 2009 by my son’s OT, who felt that he would need it for anxiety. The facts that he was only a kindergartner at the time and that the suggestion came to me from a school team member rather than a medical professional caused me to have a very negative reaction to the idea.
In the spring of first grade, Michael had some extreme behavior problems, and the school was asking about it again, so I began taking him to a psychiatric nurse practitioner to get an informed opinion from the appropriate professional, if only to make them stop bringing it up.
With her help, we first worked with the school and his psychologist to address his issues without medication, and it was only after we got to the spring of second grade and saw the same types of major issues that I agreed to consider a medication trial. By this time, we had also had a full evaluation done (for the first time since he was 5) and were given independent recommendations regarding medication from that source as well.
At that point, it was May 2011, and here’s part of what I wrote about the whole idea:
Considering medication is a big step for me. It is scary to consider possible side effects, both short term and longer term that may yet be unkown, plus I keep wondering if there’s something else we could do that would help.
I have even considered moving him to a more restrictive environment at school for part of the day. Although that may be helpful or necessary at some point, we do see the mood swings no matter what environment he is in, even when he is completely in control of what he is doing.
After discussing the specific issues that Michael was facing and the pros and cons regarding medication for each of them, we decided to do a trial of Risperdal for his mood instability, with a follow-up two weeks after starting the lowest dose. We also did not tell anyone at the school except for the nurse about the trial, so that we could get some objective feedback on how he was doing.
Surprisingly, we saw an improvement not only in his mood, but also with his ability to organize his thoughts. Here were some of my comments at the time:
After two weeks, we have not seen any negative reaction to the meds, and we have seen some positive things that cause us to be cautiously optimistic about it.
He has been more communicative with us, sharing stories about what happened in school and expressing concern for his dad’s feelings. He also came up with a plan to do chores to earn money for a video game that he wants!
Things continued to improve as we reached the halfway point of the summer months:
He has been on .2 mg of risperidone since mid-May, and we have continued to see a huge improvement in his mood, as well as more flexibility and organized thinking.
During his two weeks at the babysitter’s he only had 2 or 3 outbursts, and only one of those included aggression. And he has only had 3 aggressive incidents during the first four weeks of his summer program. This is a huge improvement over how school was going and is even better than he did last year at the same sitter and program.
Going back to school was the biggest test, and even that has gone remarkably well. Michael has met his goal with regard to timeouts at school both months so far, even with his full-time aide leaving to take another job and the agency/school scrambling to cover even a few of the hours.
Because he responded so well to the smaller dose, we did not increase it at all and he is continuing at that level even now. As long as it continues to work well and there are no adverse indications from the twice yearly blood tests, we plan to keep giving it to him for at least a year before deciding on the next steps.
My best advice if you are considering the use of a psychiatric medication for your child is to find a qualified professional with strong knowledge and experience in this area, clearly identify the major issues you are dealing with and implement any non-medication related suggestions that may resolve them first.
If you do decide on a medication trial, have a clear time frame and know the criteria you will be using to evaluate the outcome and make the decision regarding ending it, continuing it or changing it in some way. And remember this is not a once and done decision, but an ongoing question to be answered as many times as necessary based on your child’s best interests.
Note: This post was written for the S-O-S Best of the Best, Edition 12: Medications and Their Use with Special Needs Kids, which will be published on November 15th.
