Question: My child’s school is recommending psychiatric medication. Should I?

First off, listen carefully to the behaviors that the staff are reporting but don’t take the medication plunge just yet. Generally, school staff have no training or experience in: 1) prescribing “psychotropic” medications and 2) accurately profiling (diagnosing) which students would benefit from them. Teachers are rightfully focused on behavioral compliance, but medication should not be entered into without careful research and consideration by the parent or parents – and then in conjunction with medical professionals (more on that later). Think of your child’s body as a temple, one that is not even done being built yet! Do you want to experiment with a substance that you’re not fully educated about regarding side effects or even potential permanent effects?

Teachers are rightfully focused on behavioral compliance, but medication should not be entered into without careful research and consideration by the parent or parents.

Request a meeting with all of your child’s school staff and ask each one to describe, very specifically, what they’re seeing. Take notes. Try to get the staff to focus more on what they’re observing and less on their interpretation of behaviors. If the behaviors appear related to things at home, be as candid as possible about that with them, within the bounds of your personal privacy, so they can better understand the true nature/source of the behaviors. If you and the school staff can’t make any sense out of the behaviors, ask them to perform a functional behavioral assessment (FBA). This is where one staffer observes the child in various school settings and attempts to determine the true function of the behaviors: In other words, what’s the child actually trying to accomplish or communicate through the behaviors?

Ask the school what behavioral alternatives they could try. Schools have entire special education programs/staff who tailor Individualized Education Plans (IEPs) and behavioral plans for designated students. Perhaps they can compile a plan to fit your mainstream child. Certain special ed-like accommodations can be made for mainstream students with behavioral difficulties; these are known as “504 services.” If you believe your child may need special education services, ask them to evaluate that.

If the school speculates on a mental health disorder/diagnosis, don’t blindly buy into it. But do listen and then read up on it on your own. There is rich information on the Internet regarding childhood mental health symptoms and diagnoses. If the school’s behavioral reports fit with your view of your child’s behaviors, the school may be on to something. But keep in mind that some symptoms masquerade as other diagnoses and it takes seasoned clinical expertise to sort those out. Hyperactive or inattentive children often look like ADHD kids but are just as often not.

Some hyperactive-appearing kids are simply bored and/or highly intelligent, while some inattentive kids may be struggling with depression or family problems. Anxious kids tend to act out their anxiety, especially younger ones. Kids being bullied or abused can easily (outwardly) appear to have certain mental health symptoms. This can get quite complicated to sort through and is often well above the expertise level of most school staff.

If you do arrange a psychiatry appointment and, after careful assessment, the physician recommends a specific medication, research that medication before having your child start taking it. IMPORTANT: Be as objective, thorough, and accurate as possible with the physician regarding the behaviors you’re seeing; psychiatrists are at the mercy of the behavioral information/reports they receive, whether from the parents or via school reports. Medication is essentially the psychiatrist’s only tool; to support and supplement that, they need accurate information regarding behaviors in order to make the best-informed decision on which medication to attempt, at what dosage, etc.

Consider keeping a concise, chronological behavioral journal on your child and ask the school to do the same. Doctors are always desirous of receiving that kind of ongoing information as a robust tool in their decision-making for your child. Be aware that psychotropic medication is a somewhat trial-and-error endeavor; one medication in a given class of these medications may work well while another very similar one may not. Plus, precious few of these medications act quickly: Each one can take days, weeks, and even one to two months to reach full effectiveness, and several different medications may have to be attempted. You and your child have to be very patient while the right medication and the correct dosage are arrived at.

Lastly, I always recommend psychiatrists over family doctors, pediatricians, internal medicine doctors, physician’s assistants, and nurse practitioners. Psychiatrists specialize in mental health diagnosing and behavioral medications, while the others have less of that training and experience – sometimes much less. Don’t let the mental health stigma deter you; if you need to consult a specialist, do so … for your child’s sake.

In the next issue I’ll include a handout that I developed for parents on this topic. Some of that information may surprise or even shock you.

Jim Catlin is a licensed clinical social worker who holds a master’s degree in guidance and counseling from UW-Stout. He invites readers to submit questions and offer ideas about what they would like to see in this column. Submit questions/ideas to editor@ChippewaValleyFamily.org.