By Romaine Schubert, M.D., Pediatric Neurologist 

If you are reading this, then most likely you are considering treating your child for a neurobehavioral disorder, such as ADHD, anxiety, aggression, depression, or perhaps insomnia due to all of the above. Typically, it is much easier for parents to agree to use medication for more clearly biologically defined illnesses, such as epilepsy or diabetes. In my more than 30 years of experience as a pediatric neurologist treating many children with neurobehavioral disorders, I have found that parents generally ask themselves the same questions, sometimes to the point of torturing themselves:

  1. Am I sure that my child’s problems are serious enough to need medication?
  2. Am I just doing this to make my life easier as a parent rather than for the good of my child?
  3. Could the medication cause irreparable long term harm to my child?
  4. Have I really explored all other options to help my child?
  5. How do I know that this is the right medication for my child?
  6. Could the use of this medication turn my child into an “addict”?
  7. Is my child too young for medication?

Surprisingly, there is one extremely important question that parents don’t ask themselves often enough and that is: “What is the likely outcome for my child, if the problems are not treated with medication?”. For instance, the poor outcome of untreated ADHD is well documented, including the risk of academic underachievement, low self esteem, anxiety/depression, impulsive decision making leading to poor choices (social media!), increased risk of car accidents and – yes INCREASED risk of later substance and alcohol use. Does that mean that every child with ADHD needs to be treated with medication or that every child with ADHD who is treated with medication will have a fantastic outcome? No and unfortunately not, but nevertheless a very large number of children (around 75% ) will derive tremendous benefit from medication for ADHD. There are similar issues with untreated anxiety and depression. On average, teenagers suffer from untreated anxiety and depression for 4 years before self-medicating with alcohol and drugs. Use of medications can be lifechanging for your child, provided it is done correctly and carefully.

Clearly, there are no easy answers to any of these questions or we wouldn’t have to write a blog about this topic. Nevertheless, there are some guidelines that can help you, as a parent or guardian, feel comfortable with the decision to start medication for your child’s problems. You may want to ask yourself:

  1. Are my child neurobehavioral problems unresponsive to reasonable demands from parents, teachers, friends? Can the child be reasoned with ? Can the child adjust their behavior, when needed?
  2. Was the evaluation reasonably comprehensive? Were alternative diagnoses considered? Were psychosocial factors taken into account?
  3. Was appropriate diagnostic testing done, or was it explained to you why a particular test might not be needed (such as an MRI of the brain)?
  4. What information have I obtained from outside observers, such as the child’s teachers, therapists, sports coaches and so on?
  5. Were intended benefits and possible side effects of medications explained clearly?
  6. Will I be able to reach my healthcare provider, if things don’t work out as planned?

In my opinion, perhaps the most important factor is that you have confidence in the health care provider you have chosen to evaluate and treat your child. Remember, ultimately in life there are no perfect decisions. We can only make the best imperfect decision we can with the child’s best interest at heart and the best information we can obtain, and then trust in the relationship with the child’s healthcare providers, therapists and educators to make adjustments as needed for an optimal outcome.

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