Using medication to help with mental health challenges is becoming more common–even among children. Many children now take medications for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). Also, psychotropic medications may be prescribed for children who have autism, obsessive compulsive disorder (OCD), depression, and other mental health conditions.
“Drugs can be helpful as part of a comprehensive treatment plan that also includes psychotherapy, family therapy, and, if needed, school and community interventions focused on providing necessary supports,” says Andres S. Martin, MD, MPH, a Yale Medicine Child Study Center psychiatrist. When making decisions about medication, Dr. Martin says, it is always important to address the full context of a child’s life, including peer and family relationships, and academic and developmental progress.
What should clinicians and parents consider before starting a child on psychotropic medication?
According to Laine E. Taylor, DO, a psychiatrist in the Child Study Center, child psychiatrists weigh several questions before deciding to prescribe a psychotropic medication to a young person whose brain and body are still developing.
Mental health is a vital component of overall health and wellbeing—but medications are only one of several effective treatment approaches. So, says Dr. Taylor, a key question to be answered is whether the child can be helped without medications. “We always aim to use the fewest medications at the lowest possible dose,” she says. “So the question is whether another therapeutic approach might be used before medication.”
Next is an evaluation of the risks and benefits of a particular medication. While any drug prescribed to a child must be proven safe and effective, side effects are common and even to be expected. (For example, psychostimulants used to treat ADHD may cause sleeplessness and loss of appetite.) The answers are not always black and white.
“Side effects are one thing to consider,” Dr. Taylor says. “But at the same time, a child’s ability to be present at school and to develop relationships in a healthy manner is important, too.”
Do all children taking mental health medications need psychiatric care?
Though it is now common for pediatricians to manage ADD/ADHD medications for a patient, it is important that any child with a mental health concern first see a child psychiatrist for a comprehensive assessment. That is because some symptoms that seem worrisome—such as tics or separation anxiety—may be transient or related to development. Others may indicate problems at home, at school or in another part of a child’s life. “We have a lot of experience that brings unique insights,” says Dr. Martin.
Also, finding the right medication and determining how much a child should take require specialized expertise. “Children’s bodies react differently to drugs, and sometimes in counter-intuitive ways,” Dr. Martin says. “Kids may need higher doses of some medications than adults because they metabolize them differently. Other drugs that work well in adults may not work at all in a child.”
What are signs that a child may be taking too much medication or too little?
As with adults, finding the right medication and dosage for a child may involve some trial and error. “The ideal dose is highly variable among drugs and among children,” Dr. Taylor says, noting that when a child starts to take a new medication, the rule of thumb is “start low and go slow.”
If a child shows a partial improvement, it may be a sign that the drug is a good choice but a higher dose might be in order. According to Dr. Taylor, signs that a medication dose is too strong can be wide-ranging but may include:
- A change in appetite or sleep patterns in both directions
- Signs of confusion or differences in thinking patterns
- Any dramatic changes that are not typical for the child
Signs of allergy—such as a rash or digestive disturbance—or dangerous side effects—such as suicide ideation, which has been linked to some psychotropic drugs—should be taken seriously. Dr. Taylor says any such concerns should be brought immediately to the attention of your child’s doctor.
What makes Yale Medicine's approach to medication management for young patients stand out?
Our treatment focuses on the whole child in every context, including family, social relationships and school. And while medication can be helpful for children and adolescents with mental health challenges, Dr. Martin emphasizes that “it’s only part of the picture.” The Child Study Center offers extensive resources and expertise that can be helpful in providing the supports a child needs in other parts of life, such as for learning disabilities, anger, or relationship difficulties.
Yale Medicine is also known for expertise in many childhood mental health disorders. Working in close partnership with Yale New Haven Hospital, the Child Study Center operates several specialized clinics for children and adolescents with mental-health challenges. These include one for anxiety and another providing care for ADHD, OCD, and Tourette’s syndrome. “These are well-established, highly research-driven clinics, known for providing excellent care, including medication management, to children and their families,” Dr. Martin says.
Every aspect of a young child or adolescent’s health is important but especially the brain. Yale’s child psychiatrists are widely known for handling highly complicated cases, Dr. Martin says.
“A real differentiator is our experience treating very ill kids who are starting and stopping multiple medication combinations,” he says. “We know how to do aggressive psychopharmacological management, if that’s what’s called for. And having years and years of that kind of experience has allowed us to develop a very different level of expertise.”