An interview with Dr. Mani Pavuluri
*To investigate the other side of this issue, you can check out part 2 in our series on Kids and Medication: “The Drawbacks to Medicating Children”
When we first noticed that our daughter was struggling with numerous behavior issues, we wondered if there was something going on with her that would require medicating her. It was an extremely stressful period for many reasons, not the least of which involved my worries about medicating a young child. Ultimately, it turned out that this wasn’t what our daughter needed, but for many families this is not the case and there are so many struggles they go through in making this potentially life-changing decision. I asked Dr. Mani Pavuluri, director of the Pediatric Brain Research and Intervention Center at the University of Illinois at Chicago, to offer her insight into when medicating children has its benefits. — Gina Osher, The Twin Coach, TMC Contributor
With so much written these days about how children are being overmedicated and prematurely diagnosed, how can parents determine whether their child’s behavior actually warrants the use of medication?
Medication is something that should be considered after a thorough evaluation of the spectrum of symptoms affecting the child and parents. This is generally done if there is some serious impairment at school and at home. You want to try to parse out what could be caused by the child’s environment and what could be considered clinical symptoms of a disorder. Once that is done, you can begin to strategize about what methods would be most helpful for the child.
It may feel to some parents that it would be hard to know if a child would need medication. However, something like bipolar disorder can present itself as emotional upheaval so deep and damaging that it can destroy the home. The child may have rages, hyper sexuality, extremely loud talking, oppositionality and more. It is actually unusual for bipolar disorder or ADHD not to show up as emotional dysregulation early on as a child’s brain function is still developing. To know if an evaluation may be necessary, parents should look for three things:
- Lots of complaints from school, neighbors, parents of playmates etc.
- A child who is really hard to parent. For example, one who cries very easily, is rageful, hyper sexual, rocking, screaming, scratching arms, has long periods of anger with little provocation that is not contextual and so forth.
- A comparison of this child’s temperament with other children in family shows a marked difference in addition to any specific abnormalities in behavior.
Once you have looked at these three areas, finding a good developmental pediatrician or a doctor who specializes in pediatric mood disorders may be in order.
It’s said the number of children taking psychiatric medications for mental illness has risen dramatically in the past ten years. In your opinion, why is this happening? Better diagnostics? A shift in cultural acceptance? More toxins in the environment?
In the last decade there has been a huge improvement in the availability of medications that help things such as rage attacks and mood dysregulation. Additionally, these medications are now often available in generic form so they are affordable to a larger portion of the population. There is also a greater understanding of how children develop as well as what cognitive problems or emotional difficulties they may have. All of these things likely are a part of the reason why we may find more children receiving diagnoses and medications. However, for every one person who may be unnecessarily looking to medicate their child, there are, perhaps, more than ten families who aren’t seeking help for their children but whose children could be helped dramatically by medications.
As far as the environment, there is no evidence that toxins have increased the increase in diagnoses. However, given that the rates of cancer diagnoses have increased, it’s possible that it’s a general aberration. It’s a very interesting question, but it is very hard to get funded to do research on this topic, so we can’t yet say that there is proof for a toxic environment as cause.
What would you say to parents who have fears about giving their children medications whose long-term effects aren’t yet known?
What I find is that when patients are really benefiting from the medications, they are willing to take them. But parents resist when they are skeptical. If parents choose to not give their child medication, there needs to be a lot more work done on behalf of the parents. They must find ways to adjust their entire daily schedules, their other children’s lives, how the troubled child is to be educated, and so on. When a child who needs medication takes it, life becomes streamlined. A whole family can be damaged if everyone’s focus is on helping the non-medicated child.
These medications we recommend have been tested on adults for many, many years and children, physiologically, have human bodies, just as adults do. Antipsychotics given for adult bipolar disorder, for example, are now indicated for children 7 – 10 years old. There is sometimes concern about a side effect, such as weight gain, that in an adult may be less troublesome than in a child, so parents have to factor that into making their decisions. But overall, I believe that when a careful diagnosis has been made for a child, the results can be life changing.
Why are parents in the United States more likely to medicate their children than their counterparts in much of Europe?
Europeans, in general, as opposed to the United States, have more of a focus on psychoanalysis, Freudian psychology, play therapy, at times even thinking that the parent/mother may be the cause of child’s behavior and so forth. Of course environment shapes a child’s behavior, but many European’s beliefs about this do not take modern developments into account enough when it comes to the topic of whether children might need medication. Overall, I see this as a very backwards way to approach the question of how to help a child who may have a brain dysfunction with a chemical imbalance where medications can be very effective.
Many who decide to put their children on medication face harsh criticism from both family and from outsiders. What advice do you have for the parents who have made the tough call to use pharmaceuticals?
In the old days extended family lived nearby and spent more time together so there might have been less tendency to judge a parent’s decision to choose medication. That is, more than just the immediate family members would experience on a regular basis the full extent of how a child’s behavior patterns manifested themselves. But these days, more often than not, parents have to make this tough choice on their own. Once the question as to whether to try medication is on the table, I think there are three things to keep in mind:
- Parents have to be ready for this decision. When you give your child medication for their behavior issues, you must feel as though you have tried all other methods to help. Really search in your heart to know that you have exhausted all other possible answers to helping your child.
- Find a doctor that is trusted in the community. There are all kinds of doctors out there and there is the possibility of someone being too quick to prescribe medication. You want to start with a deep level of trust in your doctor.
- If you give medication, you see the effects within a week a so. If things are not going as expected, the effects of taking that medication are not irreversible. I believe parents can feel confident that it is a risk that can be taken.
I agree with the quote, “There is nothing noble about suffering.” If a child, and the rest of that child’s family, can be helped to live a happier and more peaceful life because he or she takes medication, I say it is better to look into that possibility rather to continue to suffer the sometimes extreme difficulties that go along with trying to avoid that option.
Mani Pavuluri, MD, PhD, is a Professor at the Department of Psychiatry, University of Illinois at Chicago (UIC), the Berger-Colbeth Chair in Child Psychiatry, and the Founding Director of the Pediatric Brain Research And InterventioN (BRAIN) Center. She is a preeminent researcher in pediatric mood disorders, who has developed many programs across the world and consults patients from nearly 30 states in the USA. Her scientific work is a trailblazer for how we understand brain circuitry function and medication effects on the brain function in young children and adolescents with mood disorders such as bipolar disorder and ADHD. Her book What Works for Bipolar Kids: Help and Hope for Parents draws on her 25+ years of experience treating children and adolescents with bipolar disorder.
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