Two years ago, I wrote a column for The Huffington Post arguing that American society needed to stop bickering about whether or not kids were "overmedicated" and should, instead, listen to the people best positioned to comment on the subject - the generation of young adults now in their 20s and 30s who spent their formative years taking the controversial drugs in question.
Two years later, I have published a book that tells the stories of some of these young adults, myself included. I can't pretend that "Dosed: The Medication Generation Grows Up" speaks for every young person who ever spent their childhood or adolescence taking psychiatric drugs, but it is the first book I know of to explore these experiences in depth.
Now that I have done all this research, however, I expect that people will want to know: Is medicating children a wise idea or not? What is a parent with a difficult, troubled or despondent child to do?
I'm not a doctor or a mental health professional, and I can't speak to whether it's appropriate for any individual child to be prescribed a particular psychotropic drug. The fact is, some kids are given medication who don't need it, while others don't get medication but could benefit from it. And some kids are put on the wrong drugs, or the wrong dosages, or in combination with too many other medications.
But if the decision is made that medication is worth a try, I can recommend some steps adults can take to help children benefit as much as possible from the experience.
Explain Why Medication Is Necessary
It's important for kids to understand why they're taking medication in the first place -- otherwise, they're likely to invent their own explanations, which can cause them psychological or even physical harm. They might think the drugs are punishment for something they did wrong, or even swallow a whole bottle of pills in an attempt to "fix" themselves, as one of my interview subjects did. Adults should explain in developmentally appropriate ways why the child needs meds, and they should elaborate on the explanation as the child matures.
Respect Kids' Attitudes Toward Their Medication
Talk to children to find out if anything troubles them about medication, and why. Are they scared their personality might change when they start taking a particular drug? Are there side effects they dislike? Are they getting teased at school because they have to go to the nurse in the middle of the day to take their meds? Some of the things that bother them may be non-negotiable, but simply by listening, you'll show them that you take their worries seriously.
Recognize That Small Changes at School Can Make A Big Difference
Some children require extensive special education services at school in addition to medication. But other kids simply need minor arrangements that may not require going through formal special education channels. Parents should consult with teachers and school mental health staff to see if small accommodations -- like having a "safe place" to go if a child gets upset in the middle of class -- can be arranged to complement and supplement medication treatment.
Find a Therapist To Discuss The Experience Of Meds
Many studies have shown that the combination of therapy and medication beats either treatment alone. But beyond that fact, I recommend trying to find a therapist who's open to discussing not just feelings, relationships, thoughts and other traditional therapy topics, but also kids' opinions and attitudes about being on medication. Taking psychiatric drugs can be stressful and confusing, and often children and teens don't have anyone with whom they feel comfortable discussing their concerns. If the child is open to it, therapy can be an ideal venue.
Make Kids Partners in Treatment Decisions
Especially as children grow older, consult them and allow them to weigh in when it comes to decisions about their treatment. If the side effects trouble the child, would it be possible to switch to another drug? Kids will feel more invested in their medication, more likely to take it as prescribed, and more optimistic about it working if they get a say in what's going on.
Accept That Not Adhering to Medication Is Normal
At some point, most kids will try to get away with not taking their medication. For many of them, especially teenagers, this represents a rebellion against the authority of their parents or doctors. Others, especially if they've been taking meds since they were very young, may just want to see what they're like without the drugs. Parents and doctors should recognize that for most children this is a phase. Adults can mitigate it, perhaps even avert it, by building a trusting relationship with kids, and by doing some of the things recommended above, like explaining the need for meds, taking children's concerns seriously, and making them partners in treatment decisions.
Gradually Increase Kids' Responsibility Over Their Treatment
Those of my peers I interviewed whose parents gave them too much responsibility too early on felt burdened and sometimes made poor choices, like stopping meds on their own, sharing prescriptions for stimulants such as Ritalin with friends, or mixing meds with alcohol or illegal drugs. But those given too little responsibility felt babied when they were younger and later overwhelmed when they moved out of the house and had to fend for themselves and manage refills, find their own doctors, remember to take meds on schedule and handle other treatment logistics. The transition to adulthood will be smoother -- and safer -- if parents and doctors gradually entrust more responsibility to kids over time.
Stay Flexible
Make sure you revisit with your child's doctor the need for medication, the type of medication being prescribed, and even the psychiatric diagnosis being assigned. Recognize that drugs can stop working, dosages may need tweaking, new symptoms may crop up and life stressors may aggravate mental illness, all of which can require changes in medication regimens. Medication, in other words, is best viewed as an ongoing, evolving treatment, not a cure. The shifting nature of these disorders can be traumatic, but it can also be a source of hope. In some cases, it means that things can get better and that medication doesn't have to be a permanent commitment.