Science Monday: Meds for kids and the counselor’s role

Recently read a NY Times article on the issue of giving children multiple psychiatric medications to manage mood, behavior, and concentration. You can read the article here. The article states that 1.6 million children (280,000 under the age of 10) were given multiple psychiatric meds last year. There is a little graphic that lists the number of people (ages 0 to 19) taking each class of medication in 2005 (with the percentage in parenthesis of those taking that class who ALSO take another class of psychiatric medication):

As you read the article and the parents’ stories of trying and suffering with and without the medications, you have to feel their pain. No parent wants to have to put their kids on medications but some feel they will lose their children if they do not.

The debate in the article is over whether there is any evidence that drug cocktails are benefiting the children. Not much debate on the science end–there isn’t any evidence yet. Reason? Its VERY difficult to do drug trials with children. Not only isn’t there many studies of multiple drugs with kids, there aren’t many studies with single meds with kids. Hence the reason we don’t really know if SSRIs given to kids cause them to have more thoughts of suicide than if they took nothing.

The counselor is often placed in the position of helping parents think through the pros/cons of placing their children on psychiatric medications. Here’s a few things I do/say (of course, along with the repeated mantra that I am not a physician and that they should bring their questions to their prescribing doctor(s))

1. Theological issues. No matter that even biblical counselors have written that they are not against medications per se, many feel that psychiatric meds are somehow unspiritual responses to spiritual issues (usually obedience matters). We can blame narrow minded christian leadership but I do not think that is really the case. We all feel badly that we need help to behave in proper ways. When this question is raised I usually have these things for the parents to consider: (a) If Tylenol treats a stress headache (maybe caused by my unfaithful response to my world) gives me a better shot at not being irritable with others, why wouldn’t it be okay to take a pill that might help me concentrate better so that I hear, remember, and follow through with my parents’ instructions? (b) pills do not circumvent spiritual matters but putting ones sole trust in chemicals does. Whatever heart issues are at play prior to meds will still be at play with meds. A side note. I find that grief about the child’s problems (e.g., this is not what I imagined my child to be like) masquerades and theological issues.
2. Social issues. What is the likely short-term and long-term consequences of your child NOT being on the considered medication? What will you do to try to manage and moderate the situation without the meds? If there might be a dire consequence to not using medication (severe social rejection, suicidal or aggressive impulses), then medications might be helpful in the short-term. For example, long-term use of antipsychotics are likely to cause significant weight gain. But, without them, the child may be in danger of hurting himself or another. The parent must weigh this difficult dilemma.
3. Persistence issues. How persistent experimental is this family? Do they have the stamina to play with medications and dosages until the doctors figure out what might be the best path for their particular child (and this is also true for the doctors–do they evidence a willingness to listen to the parents and take THIS child into consideration regarding the meds?)? If side effects are significant, are they willing to consider a second med to counter the first one (e.g., Tenex is commonly prescribed to address the inability to sleep while on a stimulant)? Further, can they see meds as only one helpful measure rather than the only one. If the parents are only looking for a quick solution, then I tend to be the bearer of bad news that meds alone are rarely enough for mental health issues.

I have also found that I am more likely to talk honestly about the side effects of medication than the prescribing physician. I’m not sure why this is but parents seem to find it helpful to have the full picture.