A Child Psychiatrist's Philosophy on Medication

Many people come into my office with some uneasy hostility to the process.

Their child is in trouble - she may have ADHD or depression, an eating disorder, or an anger problem. He may be oppositional or have a substance abuse problem; he may have separation anxiety, or struggle with Aspergers. They've been sent to me because somebody told them that this child may need medication. And the road leads through my office.

Truth be told, I would prefer not to medicate anybody. I'm a big believer in psychotherapy, family dynamics and in severe cases, placing the child in a better social environment to help them grow. You want to put as little foreign material in the brain as possible because the mind has its own way of healing.

Yet, I medicate all the time. The parents will come in and they may be upset. “I knew you were going to recommend medicine” (as if they were here for another purpose). “Can't we do it any other way?” The answer to that is usually no – not if they want it to be as effective as possible. Many of these parents have tried alternatives to medication, with unsatisfactory results. The problem here is that the child is really dysfunctional and medication may be the best way to help that dysfunction to the fullest extent.

I review the risks and the potential benefits of various medicines. But there is a risk that is intangible; yet a critical risk that parents need to know. It is the risk of not treating their child with a medicine that can help.

You see, children are a moving target. What you see at age 7 is different than at age 12. If a child has ADHD and hasn’t been treated within those 5 years, it can be extremely damaging. How many times has he been yelled at by his parents, how many times has he caused disruptions in school, how many times has he frustrated just about anyone? This is hard to deal with. These are precious years for the development of self esteem. So I tell parents that medicine may give your child a sense of competence during these years and sometimes it’s no longer needed when they’re older.

I want this child to feel good about growing up, good about school, good about experiences with family and good about his connections to friends. If medicine can help this along the way, so be it. You have to remember that not treating somebody is also a treatment decision, and not giving medicine that can help is a decision to deprive the child of something that can make things a lot better for them.

If you don’t have a good alternative, then you may be giving a child a bad experience for years that he may not be able to overcome. When parents leave my office, they’re sober in their choices and often decide to medicate their child. Years later they are usually grateful for the decision. It’s a heavy decision to use medicine with your child - but it’s a decision that can sometimes lead to a better life.