Steph B asked “I just read your post on using medication as part of treatment. I resisted medication for my child for a long time, but I can truly see the benefits of it now, and he's been taking it for a year. My question relates to "how long" and "thinking long term". If the medication is helping, and behaviors and other things improve, does this mean he is really improving and learning self control, and can eventually (hopefully) stop taking it? Or, does medication just "mask" other problems that then don't get addressed because they're not as visible? Or, is the medication hopefully allowing the brain to continue to develop and mature, and that over time he can learn the skills of self-regulation that he needs without having to use medication? Thanks! :-)”

I am sure that there is a group of parents out there who wrote me off after I suggested medication as a treatment alternative, and have never forgiven me.  The underlying assumption is that “to medicate is to sedate”.  Where a patient is sedated, that reflects significant side-effect and the trial should probably be stopped.  If medication doesn’t help DRAMATICALLY, it should probably be stopped, trying something else or possibly increasing the dose for more optimal benefit.  The primary care physician should actively be involved in the decision-making.  Your question is a good one.  The fear for many is that medication is for a lifetime.  After all, the diabetic child requires insulin for life.  There aren’t too many others, however, that fit in the category of “definite”. 

My experience has been that “it depends”.  On what, I am not sure.  An “over-aroused” brain does not learn efficiently.  Patients I have followed are reported by parents and teachers to improve with medication in their ability to process information (i.e., learn), develop socially, and mature.  It has been my observation that if we can “quiet” the system, not to be confused with “sedate”, functional capacity and learning progress.   To answer the question for “How long?”, it depends upon the specific individual and the individual neuropathy (e.g., problem with the brain).  Concerns should always be discussed in collaboration with the primary care physician, but my experience is that many are able to do without at some point.  A controlled trial period off medication should be considered regularly, perhaps yearly for some, with the blessing and support of the primary care physician.

For the question “Are they really learning self-control and improving?”  My experience has been yes.  My frustration is that there are no studies that I am aware of that demonstrate such.  I do not believe that medication “masks” but rather “facilitates control”, reducing the “neurogenic irritability” and “over-arousal”.  It allows the child to be more themselves.  I also firmly believe that by reducing the extreme behavior generated by brain injury, development progresses more optimally, social skills are acquired, all of which facilitate development of the brain and more mature behavior.

With children, very early in their development, their nervous system can learn, potentially altering the course of development.  As they grow older and increase their ability to monitor, learn, self-regulate, socialize, much changes and should be encouraged and reinforced (e.g., high levels of feedback).  The ultimate goal for these children is the same as for other children.  We want to maximize our child’s potential and developmental outcome, using whatever tools available.  Medication is only a tool, one of many tools we have available.   It does not define the child but rather optimizes their developmental outcome.

Remember the saying that “It takes a village to raise a child”.  For some of my patients, it takes a small city, a good pharmacy, a supportive school, and as available, a problem-solving clinical neuropsychologist.