Medication Controversy #autismawareness

I recently got in a rather uncomfortable discussion with a stranger. She was visiting a friend who I was helping. My friend and I were working on a school assignment to observe and create and IEP for a child with disabilities. In the process I managed to stumble into a conversation about why there are so many children with autism and ADHD, and how we are over medicating kids and shouldn’t be doing that. There was difficulty with a language barrier, and she did not know that my son is autistic, ADHD and currently medicated. It was a hard conversation.

My family is against medicating my son. They think his behavior and talents are normal to extraordinary, and that his energy level makes him cute and engaging. Medication in all forms is evil, but psychiatric medication is especially dangerous and useless. I used to agree with that naive presumption. Then I encountered my own depression and anxiety. I had severe post-partum depression and panic attacks that only responded to medication. Years of trying different therapies and having psychotherapy proved that there is chemical imbalance in my brain and that without medication I am clinically depressed and anxious. The failure of my thyroid gave me insight into psychiatric hospitalization, which is something that I hope my son never has to go through. It isn’t pretty. After I spent two years being seriously ill and near death, my son became extremely withdrawn, angry and depressed. His anxiety levels skyrocketed and his distractibility was so much that he was struggling in all areas of his life.

When I had a good month I asked his pediatrician to evaluate him for ADHD. We did the standard forms and questions and when he checked out positive for ADHD, my pediatrician was shocked, as he would have diagnosed my son with oppositional defiant disorder instead of ADHD. I knew my son had ADHD after watching him swing from the doors and go through all of the doctor’s stuff impulsively while simultaneously having a serious case of bronchitis. I think I had known for years, but put it off until it started to interfere with his education. While there are behavioral interventions that are useful, I was in no condition to work with him on that level, and so we chose to try medication. My son was put on a low dose course of Strattera, and we saw almost immediate and drastic improvement in his reading and his ability to focus in school. His teacher saw results too, and we were pleasantly surprised at how well he responded to the medication. For the uninitiated in medication, Strattera is a newer drug that is used for ADHD, and is a selective serotonin reuptake inhibitor, as opposed to a drug like Ritalin or Adderall, which are stimulants (think coffee or caffeine).

Ben did great on Stratterra at a really low dose for the rest of first grade, and I got my health under control. We were doing great, when suddenly his ability to handle change and stress further deteriorated. I remember the day so clearly. It was my first visit to his 2nd grade classroom following a bout with bronchitis on my part, and I watched my son nervously bite first his nails and fingers and then his wrist as he worried about an upcoming spelling test. I have seen that behavior a thousand times in him and in my autistic students, and I thought to myself, “my son is autistic”.

Rather than let my pediatrician or his very kind, but ultimately unqualified therapist diagnose this, I chose to find a professional. I have an undergraduate degree in psychology, and have been working on my Master’s degree in Mental Health Counseling. I’ve read the DSM IV guidelines and diagnostic criteria for autism, and I know a lot about mental health issues after studying the subject for years, and then through my own experiences. It was time to call in the big guns. :) There are not many child psychiatrists in our area, and even fewer that take insurance. I did a search for the two that take my insurance, and took him to the first one on the list.

Now here is where it gets tricky. Kids are ridiculously hard to diagnose and there are two methods that psychiatrists seem to rely on. The first is to diagnose them with everything possible and then, over time, weed out the diagnosis that don’t fit. The second is more conservative and starts with the most obvious and then broadens the diagnosis as needed to fit new symptoms, or changes. This method is also very broad in an effort to allow the doctor’s time to see how the patient responds to various treatments and to satisfy insurance requirements. It is also an effort to avoid misdiagnosis. It is apparently easier to remove a diagnosis than it is to add it after the fact. Our first psychiatrist gave me a laundry list of problems that my son may have, but told me that he definitely had autism, ADHD and a mood disorder. With the recommendation of Ben’s therapist, we sought a second opinion from a more conservative doctor. Since I have a family history of bipolar disorder, both put that in their reports, but the first doctor wanted him on anti-psychotics right away, which I was not comfortable with, while the second doctor was comfortable with a wait and see approach.

We started Ben on more medication. At this point they doubled his Strattera dose, which made school so much better, and gave him a mood stabilizer called Remeron, which is a drug that I had taken in the past and had success with. Apparently there are genetic trends in what medications will work best and because I had success with Remeron, they suspected he would respond to it well. The results were astonishing. He was reading whole books at school, could contain his energy as needed, and was able to control a lot of his impulses to talk out of turn and to get out of his seat out of turn. His teacher saw the difference, and has since ensured that we medicate him daily, as days without Strattera are inevitably bad days for Benjamin. I saw a major change in his mood. He was once again my happy, loving little boy. We even saw advances in his social behavior as he started to make more friends and to try to join social groups. I was amazed and am very pleased that he responded so well to our first choices in medication. We did do a brief trial of Adderal, which made him angry and manic. We discontinued that immediately.

We also have him in counseling, and his counselor specializes in dealing with developmental disorders like autism. That has helped immensely too as we have developed better techniques for handling his stress and behaviors at home. We used her techniques and advice to develop a behavior plan for Ben at home and at school which, in addition to the medication, has allowed him to stay in his regular classroom, and provided him with the structure and methods necessary to manage his anxiety, impulsivity, and frustration. He was ultimately diagnosed by two psychiatrists and a neuropsychiatrist who ran extensive testing on him with autism, ADHD, dyslexia and a mood disorder. He is very high-functioning autistic and twice exceptional as he recently was tested for GATE and passed. On the one hand he is very smart, and with his ADHD under control he is able to demonstrate that. On the other, his behavior reflects that of a 4-year-old and will require a lot of teaching.

So, back to the awkward conversation with the stranger. Yes, I agree that we overmedicate children. It is easier to medicate them than it is to look for an underlying cause for the behavior, or put in place an elaborate behavior management plan. School and the world are not designed for children like my son, or children with ADHD. If I could homeschool Ben I probably would, but I love his teacher, school, and the friends he has there. I think he needs to go to school to gain the social skills he lacks. He may not always do well in school and there are still bad days, but medication allows him to function in an environment that he finds highly stressful and overwhelming, and that is a good thing.

If your child is struggling in school, at home, and generally across situations, I would recommend finding a child psychiatrist. I would not trust medications that alter brain chemistry to a pediatrician or family practitioner. Not in a child. Too many medications are designed for adults and they all have side effects that must be dealt with. The manic reaction to Adderall is an example of something that my pediatrician might not have known to look for, but the child psychiatrists were very familiar with and warned me about before I even gave him the medication. They are also much better at finding the right dosage and ensuring that he medications do not have any adverse interactions. This is not something that I took lightly, and I sought several opinions about the diagnosis and medication before we settled into our routine. Ultimately it was his inability to function at school and his depression that triggered my decision to medicate my son. I want him to be successful. He was trying hard, and his teacher and I had in place many behavioral plans, but they were ineffective. Counseling was even ineffective. When I took him to his counselor at the beginning of this school year, she had not seen him all summer. She saw and remarked on the huge change in mood and behavior that we saw in my son. Without medication I worried about his ability to handle everyday life and its stressors. On medication he is happy and functional. He doesn’t like swallowing the pills, but he likes feeling better and doing better in school. Even he can see the difference.

Medication is controversial, but in some children there is a real need. I would not deny my son medication that helps him based on prejudice or the opinions of others, however, I would seek the highest quality of care and the best diagnostic and medication management available. When managed by a professional well-versed in childhood disorders medication is a powerful tool for parents in aiding their children. I would not deny my son antibiotics if he had an infection, and in some ways this is the same. But, as with antibiotics, I am careful about what type and how much he takes, and worry about the long-term effects. Ultimately our goal is to raise a healthy, happy, functional child. Hopefully in the future we will be able to find alternatives to psychiatric drugs, but if we don’t I’m okay with that because I know I have gotten him the best care that we can afford or find in our area.

The moral of this story is don’t let your child suffer or struggle simply because of social pressure, or cultural norms. Some children truly need and benefit from medication. On the other hand, don’t medicate your child simply to make life easier, or because your pediatrician suggests it. Get a specialist involved, try counseling, look at diet and nutrition and its role, make a behavior plan, and incorporate medication as part of a whole life, whole child treatment.

Photo: faungg/Flickr

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