To Medicate or Not?
Navigating the maze around psychotropic medication
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The decision of whether or not to medicate a child diagnosed with ADHD, or anxiety, is a deeply personal and often fraught one for parents. In this week’s episode, Dr. Robert Jaffe, Associate Professor of Psychiatry and Pediatrics at The Mount Sinai Hospital, Program Director for the Child and Adolescent Fellowship, and Director of the Mount Sinai Tourette Association of America’s Center of Excellence, sheds light on the multifaceted nature of this decision, and offers valuable insights for parents grappling with this issue.
One of the primary challenges parents face, as they begin to navigate the waters around treatment and medication, is the overwhelming amount of conflicting information available. All of us are bombarded with headlines about a mental health crisis among young people, rising rates of diagnoses, and concerns about both over- and under-medication. This can leave parents feeling confused, anxious, and unsure of what to believe.
“The landscape around ADHD, anxiety, and medication is overwhelming and confusing.” Dr. Robert Jaffe
I’ve boiled down our conversation into 5 key points regarding medicating children for ADHD or anxiety:
Trust your parental intuition: If you feel something is off with your child, seek professional support.
Ultimately, you know your child best. If it feels like something is “off,” or that your child has had a marked change in their behavior, it is a good idea to reach out for help. Remember that “help” does not necessarily mean medication. There is a wide variety of treatment options available. Be mindful if your “gut” is messing with you due to your own anxiety and check in with a trusted professional and other people in your child’s life to confirm any concerns you have.
“My first and foremost recommendation to parents is always to trust your gut, and trust your parental intuition.” Dr. Robert Jaffe
Consider the severity of symptoms: Is your child experiencing severe symptoms that significantly impact daily life? Are the symptoms more mild? Do they come and go? What helps? How is their sleep? Friends? Eating? Exercise? Having a complete assessment (Dr. Jaffe warns that these appointments are not short) means considering all aspects of a child’s life.
The severity of a child's symptoms plays a crucial role in determining the appropriate course of action. Medication may be more suitable for severe symptoms that significantly impact daily life, while therapy can be effective for mild to moderate symptoms. Therapy can also be used in conjunction with medication, offering a more holistic approach to treatment. A comprehensive evaluation with a trained professional serves to identify the root causes of a child's symptoms and develop a personalized treatment plan.
Explore therapy and lifestyle changes as a first option: Therapy can be effective for mild to moderate symptoms, alongside the effective impact of regular exercise and good sleep. Once these are addressed they can be combined with medication if needed.
As many of us can attest to, the option to get our children into therapy can feel like an easier pill to swallow (pun intended) than medication. Therapy can support children without the use of medication by helping them develop coping skills and resilience, providing a safe space to explore their emotions, and teaching them strategies to manage symptoms of anxiety or ADHD. It can also address any underlying causes of their difficulties, such as family or school-related issues.
“Many times we can really significantly mitigate symptoms just by impacting the environment. There's no need to go to a medication right away, or target the underlying biology right away.” Dr. Robert Jaffe
Medications are safe and effective when used appropriately: They can help children access their full potential and improve their quality of life.
The potential side effects of medication are a major concern for many parents. Though Dr. Jaffe emphasizes that medications are safe and effective when used appropriately, and that they can significantly improve a child's quality of life, he also encourages families to have open and honest conversations with their child's doctor about potential side effects. Parents also play a role in monitoring their child closely for any adverse reactions. The stigma surrounding mental health and medication can also be a significant barrier for parents. Many parents worry about their child being labeled or judged if they are diagnosed with a mental health condition, or prescribed medication. It's important to remember that mental health is just as important as physical health, and that seeking help is a sign of strength not weakness.
Focus on building resilience and coping skills: These skills are essential for managing symptoms and promoting long-term well-being.
As with all things in the child development space, the importance of building resilience and coping skills in children cannot be overlooked. These skills are essential for managing symptoms and promoting long-term well-being. Though therapy can be instrumental in helping children develop these skills, parents can also play a vital role by modeling healthy coping mechanisms and providing emotional support.
Finally, stay away from blame and shame (yours, theirs, or anyone else’s). While there is a genetic component to these conditions, environmental factors also play a significant role. It's important to remember that there is no shame in seeking help for your child. Mental health challenges are common, and there are effective treatments available. By addressing these challenges early on, parents can help their children reach their full potential and live happy, healthy lives. We can use our relationship to support our children through whatever challenges they face.
“There are very few diagnoses that I can think of that are exclusively environmental or exclusively biological.” Dr. Robert Jaffe
Ultimately, the decision of whether or not to medicate a child is a personal one that should be made in consultation with a qualified professional. There is no one-size-fits-all answer, and what works for one child may not work for another. What we can focus on is educating ourselves about the available options, seeking professional guidance, and trusting our instincts as parents. That way, we can make informed decisions that are in the best interests of our children.
“It is frustrating to see families suffering because those around them have a strong opinion either for or against medication.” Dr. Aliza Pressman
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