Clinical Reference Systems: Pediatric Advisor 10.0

Medication may be an important part of the treatment for several psychiatric disorders in children and adolescents. A doctor's recommendation to use medication often raises many concerns and questions for both the parents and the youngster. The physician who recommends medication should be experienced in using it to treat psychiatric illnesses in children and adolescents. He or she should fully explain the reasons for its use, what benefits it should provide, its unwanted effects or dangers, and treatment alternatives. Children and adolescents should be included in the discussion, and words should be used that they understand.

Psychiatric medication should not be used alone. It should be part of a comprehensive treatment plan, usually including medical psychotherapy.

Before recommending any medication, the psychiatrist examines the youngster and makes a thorough diagnostic evaluation. In some cases, the evaluation will include psychological testing, laboratory tests, and consultation with other medical specialists.

Psychiatric medications may be prescribed for a number of problems, from bedwetting to psychosis. The major categories of psychiatric medication are:

• Stimulant medication, such as Dexedrine or methylphenidate (Ritalin). Stimulants are useful as part of the treatment for attention-deficit/hyperactive disorder.
• Antidepressants. These medications are used in the treatment of serious depression, school phobias, some other serious anxiety disorders, bedwetting, some bulimic-type eating disorders, and attention- deficit/hyperactive disorder.
• Antipsychotic medication, such as Haldol, Stelazine, or Thorazine. These tranquilizers usually give more inner control to the psychotic patient and stop, or at least take the panic out of, irrational beliefs and hallucinations.
• Lithium and carbamazepine (Tegretol) are very helpful in treating and preventing manic-depressive episodes.
• Anti-anxiety medications. These drugs are used short- term for certain conditions associated with high anxiety. Because their usefulness in children has not been well studied, they should be prescribed only by a physician with experience in their use.

When prescribed appropriately by an experienced physician, medication may help children and adolescents with psychiatric disorders feel restored to their normal selves. Psychiatrists stress, however, that medications may have unwanted side effects as well as beneficial effects. These side effects may range from just annoying to very serious. Psychiatric medication should be used as part of a comprehensive plan of treatment with ongoing evaluation and, in most cases, medical psychotherapy.

By asking the following questions, children, adolescents, and their parents will gain a better understanding of psychiatric medications:

1. What is the name of the medication? Is it known by other names?

2. What is known about its helpfulness to other children who have a similar condition to my child's condition?

3. How will the medication help my child? How long will it be before I see improvement? When will it work?

4. What are the side effects that commonly occur with this medication?

5. What are the rare or serious side effects, if any, that can occur?

6. Is this medication addictive? Can it be abused?

7. What is the recommended dosage? How often will the medication be taken?

8. Are there any laboratory tests (for example, heart tests or blood tests) that need to be done before my child begins taking the medication? Will any tests need to be done while my child is taking the medication?

9. Will a psychiatrist be monitoring my child's response to medication and make dosage changes if necessary? How often will progress be checked and by whom?

10. Are there any other medications or foods that my child should avoid while taking the medication?

11. Are there any activities that my child should avoid while taking the medication? Are any precautions recommended for other activities?

12. How long will my child need to take this medication? How will the decision be made to stop this medication?

13. What do I do if a problem develops (for example, if my child becomes ill, doses are missed, or side effects develop)?

14. What is the cost of the medication (generic versus brand name)?

15. Does my child's school nurse need to be informed about this medication?

Treatment with psychiatric medications is a serious matter for you and your child. You should ask these questions before your child starts taking psychiatric medications. You and your child need to be fully informed about medications. If, after asking these questions, you still have serious questions or doubts about medication treatment, you should feel free to ask for a second opinion by a child and adolescent psychiatrist. Parents seeking a local child and adolescent psychiatrist may contact:

American Academy of Child & Adolescent Psychiatry (AACAP)
3615 Wisconsin Avenue, NW
Washington, D.C. 20016

(202) 966-7300