I am often surprised at how quickly children and young adults with developmental and mental health challenges are placed on psychiatric medication.
Parents frequently report that their child was given a prescription for medication following a brief visit to their primary care doctor. The decision to use prescription medication to address emotional and behavioral symptoms in children is one that should be arrived at carefully. Children and young adults can exhibit emotional and behavioral symptoms for many reasons, and these reasons should be thoroughly investigated before prescription psychiatric medications are considered. Here are some “red flags” that may indicate a rush to medication before appropriately investigating symptoms and pursuing other appropriate options.
- The prescriber gave your child a prescription for psychiatric medication after a brief office visit.
Without thorough information it is impossible to provide appropriate solutions. If a need or challenge rises to the level of considering medication, then it deserves a thorough investigation. This cannot be done in a brief office visit. I would argue that it takes at least one hour to gather the information necessary to know whether medication should even be on the table as an option. Often, over the course of a more lengthy discussion and observation, details come to light that can provide helpful solutions. Brief interactions focused on gathering only an overview of history and challenges, and a very brief observation of the child, is not enough to determine whether medication is appropriate or what the best option might be.
- The prescriber did not gather a complete health history.
As noted above, detailed information gathering is essential for appropriate treatment. Thorough investigation of a child’s physical health is necessary to determine and prioritize strategies. It can be the case that small details in a child’s history yield the most helpful information about the root of the symptoms and what would be helpful to solve the problem. Parents should attend appointments prepared to provide thorough background information and health history. Practitioners should probe for details about a child’s past and current health, illnesses, chronic physical symptoms, and more to determine if there are issues requiring attention before psychiatric medication is prescribed.
- The prescriber did not gather information on your child’s functioning in multiple environments.
Understanding how a child functions in various environments is key to understanding the nature of the problem. If a child functions poorly in one specific environment, such as school, but does well in other environments then the focus needs to be on identifying what needs to happen in that environment for the child to be successful. Gathering information from multiple environments and adults via questionnaires, observation, or other data is vital to fully understand symptoms and appropriate interventions.
- The prescriber did not discuss or develop a plan for non-medication options before prescribing medication.
It is a very rare case where medication should be considered as a first-line option for developmental or mental health symptoms. Time should be spent discussing and implementing appropriate non-medication interventions first. Prescribers should develop a plan to address the problems that does not include medication, or refer families to appropriate professionals who can develop a treatment plan, before prescribing medications. At a minimum, prescribers should ask parents for detailed information about everything they have tried prior to looking at medications to ensure that medications are not utilized before potentially effective non-medication options.
- Medication was prescribed before making changes in home and/or school environments.
Too often it is the case where non-medication strategies are discussed, but time is not spent on implementation and refining these strategies before medication treatment starts. A specific plan to support symptoms should be developed, and time given to tracking the implementation and results of these interventions, before moving on to medication trials. If the prescriber is unable to provide implementation support to the family, they should be referred to a professional who can assist with implementation guidance and tracking changes.
When making a decision as serious as placing a child on psychiatric medication, working with practitioners who take time to gather information and discuss options is key. Parents should expect that their child’s medical providers take time to gather history and details, and discuss a comprehensive plan that goes beyond prescription medications. If a parent is feeling unheard, or is concerned that their child’s prescriber hurried through the process, it is important to discuss these concerns. Ultimately, the more information that is gathered the better the treatment plan will be.