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Man arrested if not medicating child with drugs { June 7 2004 }

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Pills vs. Talking
When It Comes to Mental Illness, Parents Face Dilemmas Over Medication, Talk Therapy
By Bryan Robinson
June 7, 2004-- When Chad Taylor noticed his son was apparently experiencing serious side effects from Ritalin prescribed for attention deficit hyperactivity disorder, he decided to take the boy off the medication. Now, he says he may be accused of child abuse.

In February, 12-year-old Daniel began displaying some symptoms that his father suspected were related to the use of Ritalin.
"He was losing weight, wasn't sleeping, wasn't eating," Taylor told ABC News affiliate KOAT-TV in New Mexico. "[He] just wasn't Daniel."

So Taylor took Daniel off Ritalin, against his doctor's wishes. And though Taylor noticed Daniel was sleeping better and his appetite had returned, his teachers complained about the return of his disruptive behavior. Daniel seemed unable to sit still and was inattentive. His teachers ultimately learned that he was no longer taking Ritalin.

School officials reported Daniel's parents to New Mexico's Department of Children, Youth and Families.Then a detective and social worker made a home visit.

"The detective told me if I did not medicate my son, I would be arrested for child abuse and neglect," Taylor said.

A spokesman for New Mexico's Department of Children, Youth and Families told KOAT-TV that they could not comment on the case because of state confidentiality laws. John Francis, a detective for the Rio Rancho Department of Public Safety, said that Taylor was not threatened but told KOAT-TV that parents could be charged in situations like his.

"People can be charged with child abuse, child neglect or various other crimes involving a child," he said.

More Kids on Antidepressants

Taylor is among many parents facing a dilemma over whether to medicate children who suffer from mental disorders. A recent study by Express Scripts Inc., a medical benefits management company, found antidepressant use increased 49 percent among consumers younger than 18 between 1998 and 2002. Preschoolers up to age 5, the study found, were the fastest-growing users of prescription antidepressants.

Some parents have been concerned about overmedicating their children and the potential short- and long-term effects of the drugs. Some have wondered whether their children would receive the most benefit from medication or talk therapy.

Despite these concerns, experts say parents should never take their children off medication without checking with the child's doctor.

"I would never recommend that anyone take themselves or their children off prescribed medication without first consulting their doctor, particularly if they're taking multiple medications," said Jay Reeve, senior psychologist at the Children's Inpatient Unit at Bradley Hospital in East Providence, R.I.

What Is the Best Approach?

There has been debate over whether medication is more effective than psychotherapy in treating children and adolescents with serious mental illness. A study sponsored by the National Institute of Mental Health found the antidepressant Prozac helps teenagers battle depression better than talk therapy. But the study also found a combination of the two methods produces the best results.

Experts agree that a combined medical and psychotherapeutical approach could be the best way to battling depression in teens and adolescents. But the approach depends on the severity of the illness.

"Medication can be a very helpful component of treatment for children and adolescents with depression, but medication alone is rarely an adequate or sufficient intervention," said Dr. David Fassler, clinical associate professor of psychiatry at the University of Vermont's College of Medicine.

"It should only be used as part of a comprehensive treatment plan, individualized to the needs of the child and family," he said. "Most children and adolescents tolerate medication well, with minimal side effects. But all children taking medication need to be monitored closely to make sure the symptoms are improving and to identify any potential problems or reactions."

The Children’s Challenge

Doctors say treating depression in children — especially young children — is difficult because they generally are not able to explain their feelings or give sophisticated answers to questions about their moods.

Unlike teenagers and adults, they sometimes cannot link events in their lives to their feelings — or at least eloquently explain how an experience affected them. Most often, children lash out, showing signs of trouble either through various kinds of misbehavior or through drawings at school.

"Generally speaking, the younger a child is, the more difficult it is to diagnose the illness," said Reeve. "It's safe to say the younger you go, the more difficult it is to distinguish one disorder from another."

Children's general lack of sophistication plays a role in the difficulty in determining whether they suffer from a mental illness and whether they would benefit from medication, psychotherapy or both. Some critics argue that many primary care physicians are not adequately trained in diagnosing illnesses in children.

"There are so many providers that are dispensing antidepressants to children and teens without appropriate knowledge and skills to administer these medications, as well as without accompanying cognitive-behavior therapy, which is critical in the improvement of depressive symptoms," said Bernadette Melnyk, founder and chairwoman of the National Association of Pediatric Nurse Practictioners' Keep Your Children/Yourself Safe and Secure Campaign.

She said many doctors do not evaluate children for depression. "In a recent survey of over 600 providers from 24 states across the country, we found that many providers are not screening routinely for depression in children."

Doctors also sometimes misinterpret behavior that stems from depression as a symptom of attention deficit disorder.

"Many children with depression also are being misdiagnosed with attention deficit disorder," Melnyk said. "Younger children with depression often present differently than older children. That is, they are most likely hyperactive and restless, versus sad and depressed."

Do Your Homework

For parents, mental illness in kids can be frightening, especially if their children are having suicidal thoughts or showing suicidal behavior. In severe cases like these, immediate medical intervention can save lives and a subsequent combined medical and talk therapy could be the best remedy. Still, every case is unique and treatment strategies should fit a child or teen's individual needs.

But sometimes parents panic when they see what they believe are adverse side effects in their children after they begin taking medication. To avoid any misunderstandings or rash decisions, experts recommend that parents do their homework. Thoroughly research mental diseases and treatments and consult the child's physician about the disease and potential side effects of medication. It also helps to know the qualifications of the child's doctor.

"Parents need to be advocates for their children," Fassler said. "They need to ask lots of questions, and they need to get as much information as possible about both the diagnosis and the treatment options."

Meanwhile, Chad Taylor remains convinced that he has made the right decision for Daniel. He says his son is acting like himself again, but officials are continuing to monitor Daniel's case.

Taylor told KOAT-TV he is not putting Daniel back on Ritalin, no matter what the consequences for himself may be. "Yeah, I'll go to jail for it," he said. "I'll go as long as I have to go."

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