Mental health is a delicate balance of the holy trinity- biological, psychological, and social factors. Medication acts primarily on the biological side.
If only it were that simple. Mental health medication is still highly stigmatized. I’m sure we’ve all heard horror stories of the kid who was put on something that turned him into a blank zombie. Sure, he wasn’t bouncing off the walls anymore, but he also lost his personality.
On the other side, maybe you’ve seen the kid whose parents chose to give her only natural medicine for her ADHD. She’s completely unable to focus in class and she’s falling farther and farther behind grade level each year.
Or maybe you know a kid whose medication is helping him get through seventh grade. For the first time, he’s able to be present and participate in class. Too bad it couldn’t have happened earlier. His parents have been trying different meds and combinations since kindergarten. Between the nasty side effects and ineffective dosages, he’s been held back already, and he’s missed a lot of school.
Here are some guidelines I use when suggesting that medication might be the next step in mental health care:
- You’ve tried therapy. Therapy can be great. As a therapist, it’s my go-to solution. But therapy should show progress after a few months of consistent sessions with a person your kid has a good relationship with. This is why it’s important to set concrete goals with tangible benchmarks- so you’ll know if there’s change.
- Your child is not able to perform normal tasks of daily life without assistance at a level compared to other children of the same age. They should be able to follow a string of logical instructions- for example, asking your child to finish their bath, brush their teeth, change into pajamas, and then come tell you they’re done so you can read a story. If you need to remind your child of their tasks every few minutes, there’s a problem.
- They’re falling behind in school. This is the most important reason I recommend medication. Being held back affects a child’s self-esteem, their peer group, their reputation, and their sense of self-efficacy. It’s one of the most damaging and devastating experiences at that age. Many of my adult clients who have been held back listed it as a pivotal event, even as young as kindergarten.
- They are isolated from friends. Kids who have dramatic outbursts from ADHD, bipolar, psychosis, and other disorders tend to attract labels, and not very nice ones. This keeps them from normal social activities with peers and may make them a target for bullying- or turn them into a bully if loneliness shifts to anger.
- They recognize there’s a problem and want a solution. Lots of kids I’ve talked to over the years have told me they want to be able to sit down and concentrate on their work but they just can’t. This is the big difference between the class clown’s acting out and the disruptions from a mental disorder. Most children don’t want to interrupt, do poorly, or fail classes. When there’s a problem, they know.
Medication isn’t all-or-nothing. It’s possible to give your child a dosage that will take them through the school day and wear off in the evening. Many kids take medication holidays when school isn’t in session. Some kids need the additional help so they are able to try therapy and are able to stop the medication once things are under control.
But advice from the internet can only be vague. I don’t know your child or your situation. The best way to find out how medication could work for your family is to talk to someone in person.
The first person I always suggest is your pediatrician because they know your child and they know about normal child development. Doctors aren’t as well trained in mental health as a therapist or psychologist, but they can diagnose and prescribe psychiatric medication. You can ask during your child’s routine appointments, and this is usually covered by insurance.
The next person to talk to is your school’s psychologist, if your child qualifies for services through a 504 or IEP. These services are usually free through the district. Although the school psychologist won’t prescribe medication, they can assess your child, describe the diagnosis, and discuss the possibility of medicating.
The last person I recommend is a psychiatrist. This is because most communities have very few psychiatrists, so it can take months to get an initial appointment, if you can get one at all and aren’t placed on a waiting list. When you get there, the psychiatrist likely doesn’t know you or your child, so you have to explain the history of the problem. And if there are any issues with the dosage or side effects, it can be a while before you can get in for a follow up appointment.
You can talk to your regular therapist about medication too. Therapists in California are trained in psychopharmacology- knowledge of medications for mental health issues. But therapists can’t prescribe medication or even suggest medication. They’re available for you to talk about your thoughts or feelings about medicating your child, and they can help you find local referrals for doctors, psychologists, or psychiatrists.