Monday, December 24, 2012

Being ProActive with Medication

NOTE: The following post is garnered over years of dealing with the boys' medication and the psychiatric and medical fields. I am NOT a doctor. This is all my own opinion. In the longrun please seek medical advice from someone with a medical degree.  

One outcome of the Connecticut tragedy is those with an agenda against psychiatric medications have become rather vocal. Sadly, there is the usual chorus of know-it-alls that have decided to blame psychotropic drugs for this tragedy. Now I am not saying that there isn't some kind of drug issue involved with this trauma. But the reality happens to be that psychiatric drugs if used properly and under proper supervision are immensely helpful to those who live with any number of psychiatric based medical issues.

Now don't get me wrong here either. If you do NOT want to use psychiatric meds for your child that is your right as a parent. However, if you find that behavioral changes and interventions do not help your child function on a better and healthier level you just might want to try medication. And yes, I said after you try behavior modification changes.

I will fess up right now. Both boys have been on medication since they were 5 years old. When we finally decided to put CM2 on adderall he turned to us and asked what took us so long? He knew he needed help. Honestly we all did. But we were determined to try other interventions first.

Depending on the co-morbid issues that your child deals with, will determine how many medications your doctor will recommend. However, add one med at a time over a long period of time. The "cocktail" that the boys each take has been determined in conjunction with a neurologist, psychiatrist, with input by a psychotherapist and even the pediatrician and of course me too. Any doctor that is not willing to work with others is not someone you want to trust with your child. Yes it takes a village to raise these children...sometimes a rather large village (Here, Here).

Here are a few pointers:

1. Always start out with the smallest dose possible. If the drug works at that level so much the better. If needed add new amounts of the med at very small increments over time.

2. Add one new med at a time.

3. Monitor your child's reaction to the new meds and new dose. Write down what you see or what you don't see in a log. (If there is no change it is very important to note that too) Write down how the child was before the meds, right after and different time periods throughout the day.

4. Note if you see any hostile or negative reaction. Call the doctor immediately.

5. If you see anything that sets off any alarm the doctor immediately. When CM1 had a bad reaction to risperdol within two days of taking the meds, I threw the medication away. The doctor kept insisting we try again. I found a new doctor.

6. Your doctor may want to try an SSRI for your child's autism related anxiety. Also not every SSRI has the same reaction in every patient. What works for some children has a deleterious effect on another. Always keep a journal, especially in the beginning. Some SSRIs can make your child hostile/angry, some make them weepy, some make them ditzy, some make them sleepy, some make them more anxious. The SSRI should just add a calmness/ameliorate their worries so that they can concentrate enough to sit and learn. It should be a positive outcome.
     Remember its the same with all medications. For seizures, not all medications work for every person. Even antibiotics can be hit or miss for some people. Psychiatric medications are no different and in fact need to be watched even closer. Watch for the listed side effects too....those lists are there for a reason.
     Note: Some people are frightened about SSRIs because of a medical report about the possible negative impact they pose to adolescents. (Here, Here) Please speak to your doctor if you are concerned. We spoke to our doctor and determined that the boys were not  candidates for concern. They did not fit the pattern of the profile group from the study. Remember too that the news tends to sensationalize issues and you cannot trust your child's health to the latest news cycle. But whatever your concern talk to your doctor. If they poo-poo you or get insulted that you are questioning their perspective, find a new doctor STAT. (Here) (Mayo Clinic) (New York Times)

6. The psychiatrist you work with should see your child monthly to begin with. Once your child has stabilized on the med, you and your doctor will determine a visit regime.

7. Your child must see a therapist to help them deal with their issues. Medication is not a panacea. It is only part of what they need to be able to learn to handle and deal with the issues that they confront on a daily basis. Medication in conjunction with therapy provides the best results. Ideally your child should see their therapist weekly.This is in addition to social skills groups, OT or PT or speech therapy too.

8. All the therapists and people that work with your child, should have input into how they are functioning. Ask them about your child's progress and let them tell you if there is a change in ability, focus or understanding once a new med regime begins. And don't forget to ask the classroom teacher.    
     They will see your child for 6-8 hours a day. They will see your child in every area of their life; classroom, play, specials, lunch and recess. But if the teacher tells you that your child is good, quiet and not a problem, that could mean that your child is over-medicated or the med is the wrong one.
     Ritalin makes CM2 a zombie. I didn't realize just how much until we changed to adderall. The first-grade teacher kept telling me how good and quiet he was. Sure. It turned him into a nonperson. Placid child less work for her. Adderall meanwhile allowed him to focus and at the same time didn't mask his personality. We stuck with the adderall.

9. The therapist should allow for your input and respect your observations. Also any preferred therapy choices should be a joint agreement with you. The therapist must figure out what works best for your entire family and go from there.

These are just a few observations I have come up with over the last twenty years. If anyone has something to add please put it in the comments so others can see. It's the way we help each other in this community.