When Pills Make Sense

By Andrea Sachs

When Michael Horowitz was found to have attention-deficit/ hyperactivity disorder (ADHD) at the age of 5, his mother was scared to give him pills. "I was against the medication at first, like everybody else," says Lisa Horowitz of Brooklyn, N.Y. Her first experience with Ritalin didn't change her mind. "I saw him climb the walls and run across the ceiling, and for four hours he couldn't stop stuttering." Then at her wit's end, Horowitz agreed to try another stimulant, DextroStat. "There was a complete difference," she marvels. "He was able to sit through a TV program; he was actually able to sit and learn in school; he was able to sit and play with toys for longer than a minute or two. You could tell right away that he was focusing better." Now Michael is eight years old, and medication has become a part of family life.

Over the past 20 years, psychiatric medication has become a way of life in the U.S., with more than 2 million children taking it for ailments such as depression and bipolar disorder, obsessive-compulsive disorder (OCD) and ADHD. But the drugs still cause controversy, as witnessed by the recent flap about a study showing that increasing numbers of children from the ages of 2 to 4 are taking stimulants, antidepressants and antipsychotic medications. Clearly, parents should not put their children on psychotropic (psychiatric) medications casually. But there are times when pills are the right choice, when a child is suffering or out of control or at risk of injury. The question is, How can a parent know when medication is needed?

School can be an excellent barometer of how severe the child's problem is, say experts. "The No. 1 person who notices that a child is having problems of any kind is going to be a teacher," says Dr. Harold S. Koplewicz, director of the New York University Child Study Center. "Teachers have the greatest experience with a large group of normal kids. Therefore they're very good observers of when children aren't behaving or reacting in an average way. So getting a teacher's comment that your child is more inattentive or looks sadder or seems more nervous is something for every parent to pay attention to."

That isn't to say that schools should determine a course of treatment. That is still for a doctor to decide. The child should be taken for an evaluation to a child psychiatrist, child psychologist, behavioral or developmental pediatrician or pediatrician who has spent a good deal of time working with kids who exhibit behavioral and emotional problems. Parents can get referrals from the American Academy of Child and Adolescent Psychiatry (1-800-333-7636) and the American Psychological Association (1-800-964-2000). Generally only an M.D. can prescribe medication.

At this point, you must start asking questions. First and foremost, make sure you understand the diagnosis. "The biggest error I see is that kids are put on medications without a clear understanding by the parents, the child and the physician of what they're treating," says Dr. Timothy E. Wilens, professor of psychiatry at Harvard Medical School. "Just as surgeons don't operate until they have a pretty good sense of what is wrong internally, you have to have a thoughtful evaluation process."

Many parents ask, Why isn't talking therapy enough? "Because it just isn't," says Harvard's Wilens flatly. While psychotherapy can be an invaluable adjunct to medication, doctors like Wilens and Koplewicz believe that these illnesses are brain disorders that must be treated pharmaceutically, like epilepsy. Therapy alone is usually most helpful for mild to moderate depression. While some mental problems may improve with age--autism and ADHD, for example--others persist. "Nobody wants to put his or her child on medication," says Wilens. "But it's like anything else. You don't want to put your kid on an antibiotic for an ear infection, but you know that's probably the appropriate treatment for that condition."

While there are a number of different medications, some tend to be prescribed for particular disorders. Ritalin and other stimulants are given for ADHD; Prozac and other antidepressants are given for depression, anxiety disorder and OCD; and Lithium is given for bipolar disorder (manic-depression). As long as your child takes properly prescribed medication, the treatment should be safe. Be vigilant in watching for any side effects, and report them to the doctor. A new book, The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder (Broadway), reports that some bipolar children are mistakenly given stimulants and antidepressants, worsening their condition.

Experts caution that not treating a disorder can be the greatest risk of all. One Midwestern mother recalls that her daughter has had wild tantrums and rages from the time she was a baby. At 10 years of age, the girl tried to commit suicide. Now she is in junior high, taking Lithium. While she is experiencing some dry skin, her mother says, her daughter wouldn't trade the treatment for the world. "She's doing just beautifully," her mother reports. "She takes her meds every day, and she's happy to do it."