Lucy Daniels Center mental health clinicians counsel parents about the use of medication many times each week. We recommend that parents make their decision on the basis of a comprehensive assessment of their child's symptoms, genetic background, medical and developmental history, and life experiences. Parents should consider also the extent to which there is an urgent need to reduce their child's symptoms, the recommended medication's possible benefits and risks, and the value of other treatment options.
Medications may be helpful in addressing specific aspects of a problem, but medication rarely if ever solves a problem. There are some situations in which Lucy Daniels Center physicians recommend medication for a child, as would most other physicians. There are other situations in which physicians would not agree. We believe that professionals make different choices about medication because they have different perspectives about how best to help children. Explaining these different perspectives may help parents facing the question of whether to use psychiatric medications for their child.
How changeable is personality?: Mental health professionals agree that genes and other aspects of human biology play an important role in determining personality and behavior. However, mental health professionals differ in their judgments about how determinative that role is. Those professionals who emphasize the role of biology may be more likely to assume that personality and behavior are largely pre-determined and therefore relatively fixed and resistant to change through experience. Medications are a particularly sensible approach for emotional and behavioral problems that are understood as being resistant to change through experience.
Lucy Daniels Center clinicians are among the many clinicians who believe that a child's biology merely establishes a wide potential range of what that particular child can become. We believe that each child has enormous potential to grow within that pre-determined range on the basis of relationships and experience. Clinicians with this orientation may be less likely to rely upon medication and more likely to promote a child's growth through working with the child, family, school and other relevant avenues.
Are symptoms the problem?: Mental health professionals also have differing opinions about a child's observable problems, known as symptoms. Some professionals define the symptoms as the basic problem. Since medications may reduce or eliminate symptoms, at least temporarily, it is logical for such professionals to recommend medications and thereby address what they consider to be the basic problem.
Lucy Daniels Center clinicians are among the many professionals who conceptualize symptoms as a sign of a more basic problem. According to this orientation to behavioral symptoms, a child is viewed as a psychological being, with an inner life and past experiences that continue to influence his or her present. Children are understood to generate symptoms and problem behaviors as a way of coping with their feelings and understanding their world. Clinicians with this orientation will be less inclined to use medication unless symptomatic relief is important for particular reasons, such as to provide comfort, assist with making friends or help with school success. If medication is so used, it is likely to be used with a simultaneous effort to address the underlying and, in the long run, more important issues.
Is the orientation to the present or the future?: Mental health professionals who conceptualize symptoms as the problem and emphasize biological solutions will be more likely to see the emergence of various emotional conditions in childhood as the beginning of a life-long or chronic condition. Therefore, the focus will tend to be on dealing with the current manifestation of a disorder that is expected to be ongoing. The goal will be to fight each battle anew. A reliance on the use of medications makes considerable sense when proceeding from this viewpoint.
An alternative view, endorsed by Lucy Daniels Center clinicians, emphasizes the potential of a child and family to interrupt and prevent the development of many potentially chronic conditions. Such an approach recognizes that even those conditions that are likely to be chronic can be shaped and improved, sometimes to a striking extent. This approach focuses on building capacities and achieving transformations through comprehensive and often intensive and lengthy treatments.
How well Can mental health professionals make diagnoses?: Mental health professionals also disagree about how accurately they are able to make certain diagnoses in childhood. Since the use of many medications depends upon the establishment of specific diagnoses, such as Bipolar Disorder, those clinicians who are relatively more confident in the ability to make accurate diagnoses are more inclined to utilize those medications than those who tend to be more cautious about making certain diagnoses of children. We are in agreement with those who are more cautious because children are very different, development is filled with surprises and information that can substantially change initial impressions or diagnoses often emerges over time.
We hope that our explanations help explain our view that a clinician's recommendations about the use of psychiatric medication partially depends on his or her overall orientation to a child's development, meaning of symptoms, and potential for change. Although we believe that the decision whether to use medication is an extremely important one, it may actually not be the most important question to answer. We recommend that parents also focus on these two questions: (1) Am I participating in the treatment designed to help my child address all of his or her relevant needs and issues? (2) Am I being helped to become the best parent that I can be for my child? We recommend that parents address these questions, whether or not they decide to use medication to alleviate current symptoms. With those answers, we believe that parents will be in the best possible position to help their child.
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