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Psychiatric Medications and Skill Development

Putting a child on psychiatric medication is a difficult decision for parents and physicians alike. In many situations, these medications can be a life line for the child, helping them better control their impulses so that they avoid dangerous behaviors, or assisting them in better regulation of intense and sometimes scary emotional states.  However, there are also situations in which medications are prescribed when they are not necessarily needed, or when children are placed on several different medications at once (sometimes five or more), which can have its own dangers. Deciding on the best course of treatment, especially for children with serious behavioral struggles, is a complicated and often difficult task.

A study reported in the Boston Globe highlights this struggle.  According to this article, “foster children in Massachusetts are nearly four times as likely to be prescribed psychotropic drugs as other children receiving similar Medicaid support in the state.” The article notes that foster children often have significant mental health needs, but also discusses some of the potential dangers associated with the use of psychiatric
medications, especially when certain guidelines are not consistently followed.

Fortunately, there are other treatment options in addition to medication that can be very helpful. It is important to remember that children with lagging thinking skills often demonstrate maladaptive behavior when environmental demands exceed their capacity to respond to those demands. Children in foster care frequently have numerous, severe thinking skill deficits, and at the same time, are asked to handle demands (such as transitioning from home to home, or being separated from siblings) that non-foster children are typically not asked to handle. Foster children often have histories of trauma, which can negatively impact their skill development, as well as make it more challenging for them to trust the adults who are trying to help them. Therefore, in order to best help these children, we need to clearly identify each child’s lagging skills and reduce, to the extent possible, some of the demands they are expected to handle, particularly while we are building their skills. Approaching them from the perspective that “kids do well if they can” also goes a long way toward creating (or in some cases, restoring) the type of helping relationship that these children so desperately need.

The identification of a child’s lagging skills can also be very helpful when making decisions about medications. Medications can be very helpful when addressing executive skill deficits such as difficulties with impulse control and sustaining attention. Medications can also help children better regulate their emotions. However, medication does not teach language skills such as identifying or articulating feelings, needs, and concerns, nor does it teach important social skills such as taking another’s perspective or appreciating the impact of one’s behavior on others. Medication can, however, help make the process of skill development more possible.

So, in many cases, medication can be an important element of treatment. However, it is always important to do a careful assessment of the factors that are impacting the child’s functioning, in order to match the treatment to the child’s particular needs. It is very important that this assessment look not only at behaviors that may be impacted by medications, but also identifies the environmental demands that the child is expected to meet (i.e., the problems to be solved) and the skills the child is lacking which make it difficult for the child to meet those demands, so that a treatment plan can be created which reduces some of these demands while teaching the child the thinking skills he or she needs to better handle these demands in the future. If one thing is clear from the Boston Globe article, children in foster care are in great need of a comprehensive treatment plan that addresses their complex needs in a thoughtful, compassionate, and effective manner.

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