How do you discuss psychiatric medication with kids? What does it mean to be a medicated child?

[mindinggaps]

Hi all, I've recently read the book Dosed: The Medication Generation Grows Up by Kaitlin Bell Barnett and have been spending a lot of time thinking about mental health and psychiatric medication in children. In particular, how can we best communicate with kids about medication?

As many of you know, my daugther has severe OCD and has been medicated with Prozac for close to a year. When I first posted about this, I was extremely reticent about medication use in young children and was very against starting treatment. Since then my view has totally changed and I am extraordinarily grateful we started the medication which despite some ups and downs has been a tremendous help for her. I am deeply grateful for the medication which has allowed her to have a much better chance at succeeding in life and having a normal childhood.

However, lately I've been wondering how to best communicate with her about the medication, keep her informed about treatment and ensure she is an active participant in the process. When she started she was quite young and certainly didn't conceptualize the full implications of the meds. Now she is more aware, wants to be involved and asks more questions. I want to make sure I'm handling this the best I can. The reality is she will likely be on meds indefinitely so I also want to make sure she is able to manage this a bit. 

Any advice? What are your thought on what is a very complex topic?

[Bambam]

My child was older than yours, but she was aware there was an issue with her. We visited medical doctor, counselor, psychiatrist. She did ask questions (although not many at all) of the psychiatrist. As she asked questions/wanted to change dosages/etc, I answered with the best information I had that was at her level of understanding - so the answers changed over time.  At the first, it was more of a we-are-doing-this-to-help-you vs. allowing much input from her (which would have been an absolute no). Over time, as she matured, we worked with her to help her decide what she wanted to do. 
She wanted to cut back and get off the med, so we worked with the doctor - cutting back way slower than he suggested, but he was fine with that, and trying to help her see that her responses were changing from what they had been on the med.  She desperately wanted off the med. We tried, but it became obvious to us and slowly to her (downward spiral, symptoms, etc), that she needed the med to function. She would want to try XYZ vs. the med, and we would say things along the line of, "Okay, but we have to set a deadline of XX days/weeks/whatever was appropriate, and then if this isn't working, we have to go back and talk to doctor." We went through several cycles - increased dosage/decrease/etc but my goal was ... for her to recognize that her symptoms were such she was not in a good place, and she needed to take action - and to set a deadline for taking that action vs. I'm going to do something about that if this extra exercise/whatever doesn't work (which, btw, good intentions and all, rarely happened). 

So, for me, it was trying to keep the long term goal in sight - that she would be able to manage *AND* would be willing to manage her mental health. So honestly, at the first, we gave her no input because she wasn't in a place that she could make good decisions, so she had to trust us to make those good decisions for her.  And at times during our journey, we did step up and say, I know you put this deadline for going back to doctor if your exercise plan didn't help, but things are going way worse, and I think we need to move that deadline up. You are in bad shape, you weren't in bad shape with XX, so let's go back to doctor. 

It's hard. It's balancing their mental state, their ability to function/make decisions well, their level of maturity, so many other things. Good luck! 

ETA: And I have no idea if we did this thing right or not.  

 

Edited March 11 by Bambam

[Terabith]

We started an SSRI just after turning five. Both my husband and I take antidepressants, so we just talked about how they help our brains work better and help us feel better.  We are lucky in that my kid is pretty much an optimal responder, and she can tell the difference if she’s even a few hours late with a dose, so she’s always been motivated to stay on meds. We did try going off them when she was eleven, which confirmed to everyone that they were still necessary. 

[mindinggaps]

47 minutes ago, Bambam said:

My child was older than yours, but she was aware there was an issue with her. We visited medical doctor, counselor, psychiatrist. She did ask questions (although not many at all) of the psychiatrist. As she asked questions/wanted to change dosages/etc, I answered with the best information I had that was at her level of understanding - so the answers changed over time.  At the first, it was more of a we-are-doing-this-to-help-you vs. allowing much input from her (which would have been an absolute no). Over time, as she matured, we worked with her to help her decide what she wanted to do. 
She wanted to cut back and get off the med, so we worked with the doctor - cutting back way slower than he suggested, but he was fine with that, and trying to help her see that her responses were changing from what they had been on the med.  She desperately wanted off the med. We tried, but it became obvious to us and slowly to her (downward spiral, symptoms, etc), that she needed the med to function. She would want to try XYZ vs. the med, and we would say things along the line of, "Okay, but we have to set a deadline of XX days/weeks/whatever was appropriate, and then if this isn't working, we have to go back and talk to doctor." We went through several cycles - increased dosage/decrease/etc but my goal was ... for her to recognize that her symptoms were such she was not in a good place, and she needed to take action - and to set a deadline for taking that action vs. I'm going to do something about that if this extra exercise/whatever doesn't work (which, btw, good intentions and all, rarely happened). 

So, for me, it was trying to keep the long term goal in sight - that she would be able to manage *AND* would be willing to manage her mental health. So honestly, at the first, we gave her no input because she wasn't in a place that she could make good decisions, so she had to trust us to make those good decisions for her.  And at times during our journey, we did step up and say, I know you put this deadline for going back to doctor if your exercise plan didn't help, but things are going way worse, and I think we need to move that deadline up. You are in bad shape, you weren't in bad shape with XX, so let's go back to doctor. 

It's hard. It's balancing their mental state, their ability to function/make decisions well, their level of maturity, so many other things. Good luck! 

ETA: And I have no idea if we did this thing right or not.  

 

This is extremely helpful, thank you! I really love the way you allowed her to be involved in the process and have autonomy. I philosophically think that is important, even if sometimes it may lead to difficult stretches. I like the way she was able to do a bit of trial and error and appreciate the value of the med.

One of the things for us is that realistically she'll likely need medication longer term. I think she already is starting to question that. Now is not the time to experiment, but eventually, I'd love to do a trial lowering the dose as you did.