Medication can be an effective part of the treatment for several psychiatric disorders of childhood and adolescence. A doctor’s recommendation to use medication often raises many concerns and questions in both the parents and the youth. The physician who recommends medication should be experienced in treating psychiatric illnesses in children and adolescents. He or she should fully explain the reasons for medication use, what benefits the medication should provide, as well as possible risks and side effects and other treatment alternatives. Child psychiatrists may not be available in rural areas and often pediatricians prescribe medications for children.

Psychiatric medication should not be used alone. The use of medication should be based on a thorough psychiatric evaluation and should be one part of a comprehensive treatment plan. A comprehensive treatment plan typically includes psychiatric medication with ongoing medical assessment and, in most cases, individual and/or family psychotherapy.

Psychiatric Medications have benefits and risks. Psychiatric medications which have beneficial effects may also have side effects, ranging from mild to very serious. As each child is different and may have individual reactions to medication, close contact with the treating physician is recommended. Do not stop or change a medication without speaking to the doctor.

Parents should be informed. Parents and guardians should be provided with complete information when psychiatric medication is recommended as part of their child’s treatment plan. Children and adolescents should be included in the discussion about medications, using words they understand. By asking the following questions, children, adolescents, and their parents will gain a better understanding of psychiatric medications:

  • What is the name of the medication? Is it known by other names?
  • What is known about its helpfulness with other children who have a similar condition to my child?
  • How will the medication help my child? How long before I see improvement? When will it work?
  • What are the side effects which commonly occur with this medication?
  • What are the rare or serious side effects, if any, which can occur?
  • Is this medication addictive? Can it be abused?
  • What is the recommended dosage? How often will the medication be taken? What happens if I miss a dose?
  • Are there any laboratory tests which need to be done before my child begins taking the medication? Will any tests need to be done while my child is taking the medication?
  • Will a psychiatrist be monitoring my child’s response to medication and make dosage changes if necessary? How often will progress be checked and by whom?
  • Are there any other medications or foods which my child should avoid while taking the medication?
  • Are there interactions between this medication and other medications (prescription and/or over-the-counter) my child is taking?
  • Are there any activities that my child should avoid while taking the medication? Are any precautions recommended for other activities?
  • How long will my child need to take this medication? How will the decision be made to stop this medication?
  • What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects develop)?
  • What is the cost of the medication? Is a generic form of this medication available?

If, after asking these questions, parents still have serious questions or doubts about medication treatment, they should feel free to ask for a second opinion by a psychiatrist.

(adapted from American Academy of Child and Adolescent Psychiatry, “Fasts for Families”)

Sometimes it is necessary for children to take medication during school hours. Schools have very strict regulations governing medications at school. A form completed by your child’s doctor is required and can be downloaded from the Maryland State Department of Education website. All medication must be in containers labeled by the pharmacist or doctor and an adult must bring the medication to school. Non-prescription medication must be in the original container with the label intact.

Types of Medications

There are several major categories of psychiatric medications — stimulants, antidepressants, anti-anxiety agents, antipsychotics and mood stabilizers. For medications approved by the FDA for use in children, dosages depend on body weight and age. The medications chart below shows the most commonly prescribed medications for children with mood or anxiety disorders (including OCD).

Stimulant Medications — There are four stimulant medications that are approved for use in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), the most common behavioral disorder of childhood. These medications have been extensively studied and are specifically labeled for pediatric use. Stimulant medication should be prescribed only after a careful evaluation to establish the diagnosis of ADHD and to rule out other disorders or conditions. Medication treatment should be administered and monitored in the context of the overall needs of the child and family, and consideration should be given to combining it with behavioral therapy. If the child is of school age, collaboration with teachers is essential.

Antidepressant and Antianxiety Medications — These medications follow the stimulant medications in prevalence among children and adolescents. They are used for depression, a disorder recognized only in the last 20 years as a problem for children, and for anxiety disorders, including obsessive-compulsive disorder (OCD). The medications are most widely prescribed for these disorders are the selective serotonin reuptake inhibitors (the SSRIs). SSRIs have been found to be efficacious in treating depression and anxiety.

Antipsychotic Medications — These medications are used to treat children with schizophrenia, bipolar disorder, autism, and Tourette’s syndrome. Some of the older antipsychotic medications have specific indications and dose guidelines for children. Some of the newer “atypical” antipsychotics, which have less troublesome side effects than some of the older antipsychotic medications, also are being used for children. Such use requires close monitoring for side effects.

Mood-Stabilizing — These medications are used to treat bipolar disorder. However, because there is very limited data on the safety and efficacy of most mood stabilizers in youth, treatment of children and adolescents is based mainly on experience with adults. The most typically used mood stabilizers are lithium and valproate (Depakote®) , which often are very effective for controlling mania and preventing recurrences of manic and depressive episodes in adults. Research on the efficacy of these and other medications in children and adolescents with bipolar disorder is ongoing.

(adapted from American Academy of Child and Adolescent Psychiatry, “Fasts for Families”)

Talking with Children about Medication

Many children and teens are reluctant to take medication. They may be embarrassed, don’t like to be different, or don’t like the side effects. All of these are very real concerns. It is important to honestly discuss medication with your child so they understand how the medication will help them — not change them. They will be the same person, but medication will help them control their behavior and will help the unpleasant feelings go away.

Medication is most effective when it is taken at regular intervals so there is no lapse in time between doses. Preventing medication stops and starts can produce the greatest benefit and help determine whether the medication is actually helping. Establishing a regular time to give your child their medication helps establish a pattern.

Older children and teens who take medication on their own often do not take their medication regularly or stop taking it without talking to their parents or doctor. Explain why following prescription guidelines is important. Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option.

If your child is experiencing unpleasant side effects, talk with your doctor. Medication should never have a numbing effect on a child’s energy, curiosity or enthusiasm.