Parents can go through a range of emotions from fear; shame and embarrassment; confusion and bewilderment; and disbelief when their child receives a diagnosis of a mental illness. A diagnosis, when accompanied by a prescription formedication, can raise several questions in the parents’ mind:
Will my child have to take the medication for life?
Will there be any side effects?
Will there be any long-term side effects on the brain or the body?
How will I know if the medication is working?
How can I tell if it isn't working?
Behavioral issues that accompany disorders such as intellectual disability, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) can be managed to some extent with therapy. On the other hand, children with severe mental illnesses like major depression or early psychosis will need medication to manage/treat the symptoms.
Psychiatrist Dr Eesha Sharma says, "If a child who is otherwise well presents a behavioral issue, for example, aggression, medication may not always be our first choice. We try and understand the origins of such behavior – when does the child become aggressive, how often, in what context and with whom. Once that is determined, we try and see if changes in their environment or communication patterns can help tackle the problem. But if there is a diagnosed mental illness, such as early-onset psychosis orbipolar disorder and aggression is clearly a symptom of the illness, medication becomes a significant part of the treatment."
There are international guidelines for diagnosing mental illness and neurodevelopmental issues in children and adolescents who are under the age of 16 - Practice Parameters and Clinical practice guidelines for assessment of children and adolescents.
These recommend that psychiatrists should avoid prescribing medication for children diagnosed with behavioral issues. It also states that psychiatric medication should not be used alone and that a comprehensive treatment plan — where medication is only prescribed if it improves the daily functioning of the child — should be created based on the child's diagnosis.
Some questions that parents and the treating physician need to discuss are:
What is the assessment and diagnosis?
What are the specific symptoms for which medication is prescribed?
What are the potential risks of not taking medication?
What are the benefits of medication?
What are the potential risks and/or side-effects of the medication?
Each child can react differently to the medication and any side effects should be discussed with the treating psychiatrist, who may suggest alternatives or adjust the dosage.
Can you stop medication?
In the case of severe mental illnesses like psychosis, the child may have to continue taking medication into adulthood to manage symptoms. It is not recommended that the child or the parents suddenly discontinue medication as this can lead to a relapse of symptoms and affect brain development in the long run.
In the case of neurodevelopmental disorders such as ADHD, parents can consult with the treating psychiatrist to see when they can reduce or stop the dosage. It is important to note that even children who have neurodevelopmental disorders such as ADHD may grow to have reduced symptoms as their brains develop. Psychiatrists monitor this over through childhood and adolescence to adjust the dosage or in some cases stop the medication altogether.
Written with inputs from Dr Eesha Sharma, assistant professor, department of child and adolescent psychiatry, NIMHANS, Bangalore.
- ‘Psychiatric Medication For Children And Adolescents: Part II - Types Of Medications, <https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-II-Types-Of-Medications-029.aspx>, last accessed on 19th June 2019
- ‘Psychiatric Medication For Children And Adolescents: Part I - How Medications Are Used, <https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx>, last accessed on 19th June 2019