By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.
More than 6 million children in the United States are taking psychiatric drugs — the result of a dramatic recent increase in the number of children being diagnosed with serious psychiatric disorders. The drugs, which are often not fully assessed in children, can cause serious side effects, and little is known about their long-term impact. Reporting on the phenomenon, the PBS program FRONTLINE aired “The Medicated Child” to help families sort through a range of medication-related issues and to team up with their children, doctors, and teachers to face these issues, Frontline asked Joshua Sparrow, M.D., a child psychiatrist at Children’s Hospital, Boston, and an assistant professor at Harvard Medical School, to contribute to a Viewer’s Guide to accompany the program. The Viewer’s Guide is posted at www.pbs.org/frontline/medicatedchild. This article, adapted from that guide, was the first of two parts in successive weeks in the FAMILIES TODAY column.
(This article, the first of a two-part series, accompanies “The Medicated Child,” that aired on Frontline on PBS. A more extensive version of the article appears in the Viewer’s Guide posted at www.pbs.org/frontline/medicatedchild, where the program itself may also be seen online.)
Psychiatric medication can rescue a child from a desperate future, and sometimes even save a child’s life. But such medication’s effects on children’s developing minds and bodies are largely unknown. Most psychiatric drugs aren’t approved by the Federal Drug Administration for use in children. Even the diagnosis that may occasion the drugs is challenging since “normal” behavior in
children varies widely. Symptoms like impulsivity or hyperactivity may suggest a host of diagnoses.
Parents are bound to wonder whether psychiatric drugs will really help. Many parents also wonder whether such drugs are used to control developmentally “normal” but “unacceptable” behavior. For example, hyperactivity in a child can interfere with learning and maturing — but sometimes it simply means that too much sitting-still is being demanded of the child. Even when a psychiatric diagnosis is appropriate, parents worry about the price the child
will pay. Identity and self-esteem take form in the vulnerable childhood years but last a lifetime. Taking psychiatric drugs is a tangible symbol of a diagnosis that children often misunderstand to mean they are defective. However, when treatment helps children manage more effectively at home and school, it can
bolster fragile self-esteem. In some instances, cognitive behavioral therapy or other nondrug treatments may replace medication or reduce the amount needed.
Adjustments of the school and home environment to the child’s needs may also help. Parents often can sense when psychiatric attention is warranted. The following are a few of the warning signs that parents are usually right to worry about when the signs persist and pervade — though none indicates a specific condition, nor that medication will necessarily help.
- You spend more time being angry or upset with your child, or trying to control her behavior, than having fun together.
- You realize that you are not enjoying your child, and worry that you have fallen “out of love.”
- You feel worn out or worried by your child’s behavior.
- People in the family are arguing about the child.
- You feel like you don’t know or understand your child anymore.
- Your child’s behavior changes suddenly — for example, activity level or choice of friends.
- Your child spends prolonged periods withdrawn or in isolation,
- She rarely smiles or seems happy. Her emotions seem limited mostly to anger or irritability.
- Your child’s reactions are out of proportion to the situation.
- Other children don’t like your child, keep their distance, think she’s odd or are afraid of her.
If you have concerns about your child, you deserve honest answers to your questions. Start with your pediatrician, who can refer you to a mental health professional if your child needs this kind of help.
UNDERSTANDING YOUR CHILD’S BEHAVIOR WHEN IT SEEMS ‘OUT OF CONTROL’
When parents are concerned about a child, catchall terms like “angry outburst,” “temper tantrum,” “meltdown” or “out-of-control” are bound to come to mind. But careful observation and detailed descriptions of the behavior will be more useful to parents, children, and mental health professionals as they work together to understand the behavior and then determine how they can help.
Try keeping a journal of your descriptions, and note the following:
Can you tell that your child is on the verge of an “episode”? Can he tell? Can he ask for help before it’s “too late”? Is he especially vulnerable when tired, hungry or anxious, or stressed?
What seems to set the behavior off? Sometimes there is no apparent trigger — yet there still may be one that isn’t easily recognized. Was the child’s reaction out of proportion with the trigger’s severity? Ask your child if he thought something happened that made him upset, and get a sense from him of his perception of its seriousness relative to his reaction. But try not to make him feel that you are criticizing him for reacting the way he did, since that will only make it harder for him to team up with you to work on regaining control.
Is there a pattern to when and where the troublesome behavior occurs? Always before leaving for school? When there is a transition? Separations? Only with certain friends? Only in private?
What does your child do and say during an “episode? How would you describe his mood? If he’s angry, is there some basis in reality to his concerns? Can he continue to converse? Can he be reasoned with? Does he settle down quickly if something happens that he cares about, like a friend’s visit or call? How long does the episode usually last? How often does it occur? How have you tried to help him settle down? How does he calm himself? What makes the episode worse?
Does he go right back to “normal” after an episode? Or does he seem tired or moody for a prolonged period? Can he remember what happened? Can he talk about it? How does he feel about it? Ashamed? Remorseful? Indifferent?
Does he want help? Or has he given up? Can you plan together to watch out for the warning signs and work together to prevent other episodes or to settle them sooner?
The price you and the child pay
How do your child’s symptoms affect him and the family? Have you had to change the way you and other family members live your lives? Do you all feel that you are “‘held hostage”‘ by the child’s behavior? Has the child’s performance at school or relationships with friends been affected? Does he feel that he can no longer understand or like himself?
Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.
Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.
Reprinted with permission from the authors.