People are pretty vocal about what they perceive to be the dangers of diagnosing and medicating children who have psychiatric disorders, and you can find plenty of horror stories, including the case of Rebecca Riley, but what about the dangers of not medicating children who fail to respond to non-medication interventions and could really benefit with the right diagnosis and medications?

These children and their families often live in their own torture chambers, through no fault of their own. Left untreated (or without effective treatment), the condition usually worsens, the suffering deepens, and all sorts of collateral damage may result. The child with the condition may fall behind in school, become a social outcast among his peers, and be more at risk for alcohol and substance abuse and getting into legal trouble. The frustration and anger he feels could compel him to abuse others – verbally and physically. His relationships with his parents and any siblings can become strained. He may be driven to self-mutilation or even suicide. The stress can wreak havoc on a family and drive a wedge between the parents. Feeling the strain, parents and siblings are at a greater risk of developing their own psychiatric and emotional disorders, especially if a genetic vulnerability runs in the family.

Psychiatric medications for children can change lives dramatically for the better – and even save lives – when they are used with care as part of a comprehensive package of treatment and supports for the child and family. I have practiced child psychiatry for almost twenty years now and have been blessed in this job because I can often help children and families overcome or manage conditions that had been causing great pain and suffering for the child and family.

Our field remains very much in its infancy in terms of understanding the neurology and brain science that causes illnesses such as OCD or depression or generalized anxiety, but we are far more aware of the fact that these are brain conditions and not the fault of the child or the parents. ADHD and mood disorders and anxiety disorders, along with a spectrum of autism-like disorders, are the bulk of my practice. Not every child I see needs or takes medications. Therapies, such as cognitive behavioral therapy and parent mindfulness training, as well as engaging school supports and modifications are all first line interventions for these conditions.

But there are times when these non-medication interventions are not enough and children cannot get through their day without symptoms that create great distress and interfere severely with the everyday demands and experiences of being a child. This is when careful use of medication – starting with medications that have been evaluated in children for safety and effectiveness, but sometimes cautiously expanding to medications that may have less evidence behind them – can bring enormous relief and a return to function for a child who has been out of commission.

I always talk to parents about the primary equation when we consider using psychiatric medication in a child; that is, that the potential risks of not trying medication outweigh or balance the potential risks of the medication itself. Untreated psychiatric conditions in children such as depression, ADHD, anxiety, mood disorders, and OCD carry risks of many long-term consequences, some of which can be life threatening. Not treating with medication (or trying medication) also carries risks that must be considered – risks that are often not reasonable to ignore. Medication is one tool in the toolbox as I tell families – and we only want to use it with care – but we don’t want to withhold it when doing so can cause more harm than the medication itself.

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    Last reviewed: 9 Feb 2010