By Joseph Sacks, LCSW
1. Meds are for serious situations.
My opinion in general is that using medications for your child’s ADHD and other issues, including psychotropic meds such as Ritalin, Prozac, etc., should be reserved for more serious situations. For example, if a child diagnosed with ADHD is getting B’s and C’s it is probably overdoing it to put him on meds. There are many individuals who are very successful with those kinds of grades. Focusing meds such as Adderal, Ritalin and Strattera are more wisely indicated for children who are getting all D’s and F’s and are completely not engaging in their schoolwork. Such children feel terrible about themselves and the meds can totally rescue them from a difficult situation. Meds for children with behavior problems should be reserved for those that are extremely angry and aggressive; ones who are very difficult to handle. Anti-depressants and anti-anxiety meds should be reserved for serious cases of anxiety and depression. The rule of thumb is to use meds when the damage to the child’s well-being caused by the illness is greater than the risk of the complications of any side-effects of the meds.
2. Using medications for your child's ADHD etc. only treats the symptoms, they don’t cure!
It is very important to remember that psychotropic meds only treat the symptoms of an emotional illness such as ADHD, aggression, anxiety or depression. The medications do not treat the cause of the problem, which if left untreated, will just come back after the meds are discontinued. Child Therapy, such as Play Therapy or Talk Therapy together with Parenting Counseling, go to the root and resolve the cause of the issue. So why do we need meds? Because these therapies can take months or a couple of years to kick in, and in the meantime the child will be suffering from unwanted symptoms. So it is often a good idea to take meds in the meantime to take away the symptoms, while working hard at therapy to resolve the cause, then after a year or so when the therapy starts to kick in you can gradually wean off the meds. I have seen this strategy work!
3. Child-Centered Play Therapy is very effective at resolving ADHD symptoms!
Abundant research proves this. I have gotten kids off Ritalin and Adderal with a year of Play Therapy together with Parenting Counseling! For my fascinating article about how Play Therapy resolves ADHD symptoms, click here.
4. You must use a good child psychiatrist.
In order to properly use these meds you need to find a wise, old, experienced child psychiatrist. I love pediatricians, but they don’t specialize in these types of problems. You need a doctor who sees hundreds of kids with ADHD, behavior problems, anxiety, depression, etc., per month and knows all the ups and downs of each type of medication for each situation.
5. It's worth it to pay cash for a good child psychiatrist,
who will return your calls immediately and always be available for consultation. Once a month is not often enough to adjust meds. Let’s say you start a new medication and two days later you are getting bad side effects, or the dosage is not right, you need to consult the doctor right away for an adjustment! You can’t wait a week or a month for the next appointment while your child is suffering. Usually a quick phone call and an adjustment is all that’s needed to resolve the problem and successfully find the right dosages. It is very important to remember this point! If your doctor is extremely busy, then you need to get a child therapist who will contact him for you. I do this often, I check with parents even daily and I can usually tell when I need to contact the doctor and when I don’t, and I can have him call in an adjustment as often as necessary.
6. Your child psychiatrist and your child therapist/Play Therapist should work together as a team and maintain constant contact.
It is very helpful to have two professional opinions working together. The therapist can tell the doctor what’s going on in Play Therapy, and the doctor can tell the therapist what he needs to know on the more medical side of things. The child therapist tends to go deeper and really get to know personally the child and his parents, and the doctor has so much experience seeing a couple hundred children at a time so that he can compare signs and symptoms with a volume of cases and say, “This worked with many other children, I think it will work with you, too.” In addition, your child therapist should help you interpret and understand what the psychiatrist is saying, and really break it down for you. You can ask him all the questions you want, and he can explain to you all the nuances of what each medication is supposed to do, when you won’t have time with the psychiatrist to ask him so much.
7. In addition, your child therapist can consult with teachers.
At times, I contact the teacher by email for a few days and find out how a child with ADHD is doing on Adderal 5mg, if not ideal I would relay this to the parent and then doctor who might up it to 10mg, then I check with the teacher every day for a week, who may say the child is focused better but still needs improvement, then I will relay to the parent and doctor who may up it to 15mg, and a week later the teacher may report, “Great.” The trick is to constantly monitor the meds’ progress on a daily basis and constantly check results, improvement and side effects and check with the doctor for adjustments.
8. You need to be proactive with your child psychiatrist.
Don’t be afraid to pester them to get good service. They’re working for you.
9. You are in charge!
Remember you as a parent are ultimately in charge of your child's mental health and any medication decisions. Make sure you exercise strong leadership in these decisions and don’t just leave things up to the doctor.
10. Get a good diagnosis
Make sure you get a very clear diagnosis from the very experienced child psychiatrist. You need to tease out exactly which symptoms a child has in order to figure out which meds to take. Mis-medication is unfortunately very common. For example, ADHD meds maybe given to a child who is really suffering from anxiety. If you have the resources a thorough neuro-psych evaluation would be helpful.
11. Fine-tune a combination of meds.
Often, it's not only one med but a combination of several different ones that your child needs. Don't be afraid to try out a small salad of tiny doses of three or four different meds to find out that perfect combination. You would have to gradually add one medicine at a time and adjust the dosages, always constantly checking with teachers and family members for the results of each adjustment, paying close attention to the average amount of time it takes for each medicine to kick in: for example, Adderall kicks in on the very same day and disappears that night, while Prozac takes several weeks to kick in and several weeks to get out of your system. Once you find the right combination, it’s like magic how helpful it can be!
12. Listen to your child!
Always, always check with the child to see how he or she feels on the meds! That is often a great indicator of whether each med is right for him. If a child says he feels terrible on a medication, tell your doctor right away and get an adjustment! You have to totally respect what the child feels and not force a med on him or her, if he says he doesn’t like the way it makes him feel. Get lots of feedback from teachers and family members to see if they notice anything different with the child on each meds.
13. Meds are not addictive.
Don't fear that if you start meds your child will be on them forever or will become addicted because it doesn’t happen. You can try meds for a few weeks or months and see how you like them, and there's no harm in discontinuing them. They're not addictive or habit-forming, and they don't generally generate dependence. Most of these medications are generally very safe over the long term.
14. Even if you decide not to take meds it's worth seeing a child psychiatrist...
a couple times to get his opinion and diagnosis and to have him or her collaborate with your child therapist. It will be extremely helpful to your child therapist to have the additional opinion of the child psychiatrist. They form a collaborative team which will be very beneficial to your case.
15. Never discontinue or increase the dosage of meds without the specific direction from your child psychiatrist.
Sometimes they may prescribe you to try 5 mg for a week and if it doesn't work to go up to 10 on your own, and that is fine, but it is better to consult with them every step of the way before changing any dosages.
16. Check reviews
Check all the reviews for a particular drug on drugs.com and ask your doctor about one that seems to get good reviews. Knowledge empowers you.
17. Join Facebook groups...
that focus on your particular child medication or issue.
18. Stay relaxed
If you do decide to give meds, don't stress the kid out over an occasional missed dosage. It generally won't do any harm.
19. Don’t force meds
If the child is refusing to take his meds, don't try to force him. Talk to him very openly and find out what is the real reason why he doesn't want to take them, and try to respect his decision, while at the same time trying to show him how it’s in his own benefit. Often refusal to take meds is a sign that there are parenting issues that need to be worked out in Parenting Counseling.
20. Don't fear a stigma...
like, “My child is on meds, there is something wrong with him, he is defective.” Meds are a very commonly used and very helpful tool and if your child really needs them, it is a bigger mistake to not take them, then it is a mistake to take them when he doesn't need them.
21. Monitor sleep
If the child is not sleeping at night this can be an indication of a major problem. I’m not talking about a child wakes up sometimes, or a younger child who wakes up because he wants a bottle as a leftover habit from his baby days. I’m saying a post-toddler child who is up all hours of the night. It is very damaging to his health, especially his mental health if he doesn't get at least 6-8 good hours of sleep a night. Therefore, sleeping meds maybe definitely recommended, and the damage from the side effects of the meds will be much less than the damage done by lack of sleep! Also remember to sharply lower the lights an hour or two before bedtime! Too much light keeps kids up!
22. If a child is going through severe stressors such as the separation of his parents,...
and is exhibiting significant symptoms, meds may be helpful and smoothing over the ride. Such a separation is extremely traumatic for children and developing symptoms that require meds is a quite normal reaction to that type of trauma.
23. Keep it private
Don’t tell the whole world your child is on meds. Just tell those trusted people whose advice you need.
24. In my opinion, most conditions that require meds are not genetically or biologically caused!
They are rather caused by a child who was born with a particularly sensitive temperament, who experienced certain early childhood stressors such as a stressful atmosphere at home, conflict between his parents or pressure coming from them, or an overly harsh strict disciplinary style. I'm not blaming parents, I know you love your children very much and you are doing the absolute best for them, I'm just saying that even slight parenting errors with a sensitive child can generate difficulties. This is actually wonderful news, because if I were to tell you that all these problems are genetic, there would be nothing you could do to prevent them and little you could do to cure, but since I'm telling you the problems come from the environment, that means you can completely resolve the issue by changing the child's environment through tuning up your parenting, or Child Therapy such as Play Therapy.
25. If you are still very much opposed to medicating your child,
you can treat him with Play Therapy and Parenting Counseling alone. It will just take longer to get results, and the ride may tend to be a bit rockier, as meds tend to smooth things out. Most parents decide against meds nowadays, and I totally respect their decision, but if you so choose, they can be very helpful.
Feel free to peruse my interesting blog, download one of my informative free reports, or view my video. If you are considering using medications for your child’s ADHD or other issues, and would like guidance or treatment from a child therapist in lower Manhattan, you may call me at 646-681-1707 for a complementary 15-minute consultation. I look forward to speaking with you!