Medications and nutritional supplements have an important role in the treatment of special needs children and adults. Medications are one component of a multimodal treatment approach. The psychiatrist is an integral part of an interdisciplinary team and can be the designated “team captain.” He or she has a pivotal role as an expert in the medical diagnosis and best practice treatment guidelines for each child’s specific needs. This unique expertise helps support parents in making the right intervention choices to optimize their child’s potential.
Behavioral, educational, social and communication data need to be collected from all team mem- bers before and during a medication trial. Target symptoms need to be identified and quantified. Target symptoms include 1) hyperactivity, impulsivity, short attention span, distractibility; 2) mood swings; 3) compulsive-repetitive symptoms, including stereotyped motor movements; 4) self- injurious behaviors, aggression, and tantrums; 5) anxiety, social withdrawal 6) sleep disturbance. Medications must be used in combination with behavioral treatments and educational approaches. Behavioral methods should be tried first to see how much of the severity of the problem can be reduced without medications. If a target behavior is a reaction to a particular setting (only occurring at home or school), the setting may need to be changed.
Every medication has side effects, some potentially danger- ous and irreversible. Common side effects include weight gain, irritability, sedation and sleep disturbance. Children with special needs have “paradoxical reactions.” Research shows that they have more adverse reactions and side effects than children with other disorders using the same medication. Many of the medications are not FDA approved and are being prescribed “off label.” Supplements can also have side effects.
Medication trials require patience. Although with stimulants, there is an immediate response, most other medications (antidepressants, mood stabilizers, atypical antipsychotics) take 6-12 weeks to reach full efficacy. There must be a robust response with significant improvement in target symptoms for a child to continue medications.
Be an informed consumer. Learn the risks and benefits of medications. Understand there is no “magic pill.”
