In the course of my career, I have interacted with many parents who have responded, “I would rather die than give my child medication!” While there should always be cautious consideration, often there is an avoidance of medication among parents. Many parents will do just about anything to avoid medication, the perception being that they are “sedating” their child and that there are consistent side effects to be feared. In part, there is a fear of the unknown, as well as concern for potential short- and long-term negative consequences of using medication. In considering medications, there are two basic rules.

Rule #1, “No negative side effects!” If there are negative side effects, that suggests that particular medication is not likely in the best interest of the patient. Rule #2 is that of only continuing medication in the presence of obvious, positive benefit. It is frightening to me how many times I will follow-up with a patient and parents when the child has been on medication for as long as a year, and the parent responds that they “really do not see any positive benefit.” There are some patients who do not respond well to medications. There are usually multiple alternative strategies for medication.

I try to impress upon parents that clinically they are in control. Parents are partners in making the decisions regarding medication in collaboration with their physician and others working with their child. If they are uncomfortable with potential side effects or symptoms and the physician does not listen to them or communicate the logic or reason of their decision-making, it may be worthwhile to consider changing to another physician.

In applying medication strategies, it should become a “community” event. While some parents try to “hide” or minimize the fact their child is on medication, it is very critical that parents obtain additional information from multiple sources for perceptions of the child’s behavior. Talk to teachers, child care providers, extended family, or others interacting with the child subsequent to being prescribed medication.

For most children, ongoing “trial-and-error” is necessary to identify the most optimal medication strategy. Sometimes the response is immediate and overwhelmingly positive, but usually some “trial-and-error” is necessary. Until a child is able to self-regulate most optimally, their ability to interact with their environment socially, academically, or otherwise is likely to be significantly compromised.

A critical aspect of a medication intervention is to facilitate the child’s ability to self-regulate, particularly in self-calming, actually giving the child control of their behavior. Children who experience high levels of anxiety, reactive irritability, and low stress/frustration tolerance, tend to struggle with learning because of their difficulty conceptually integrating and organizing the information being presented. An important aspect of medication or other treatment intervention is that specifically of giving the child optimal control in self-regulation, such that they can facilitate learning and acquire appropriate levels of self-awareness. That self-awareness will improve the likelihood of their learning to take control of their own behavior.

I strongly encourage parents to be active participants in the treatment process, especially as it relates to identifying success, or in identifying side effects of medication, in the event that they occur. The physician benefits from feedback from parents and preferably the child to contribute to decision-making in medication strategies. Many parents tend to be passive, leaving the decision to the physician. The physician cannot be successful without your feedback. As a parent; learn, be active, be vocal, and be a good observer.

Related Blog: The Logic of Medication as a Treatment Intervention