When to medicate?

Discussion in 'Early Childhood Archives' started by lcl, Aug 14, 2006.

  1. lcl

    lcl New Member

    any input on this drug would be greatly appreciated.

    My daughter will be 5 in October. we have struggled with the decision of taking her to see a psychiatrist since she was one and a half or so. I was afraid that they would put her on medication, and than we would go on the 'medication' roller coaster that my nephew (bi-polar, ADD, and other ) has been on.

    Well we finally took her in, after a 45 minute appointment a very renouned psychiatrist thought that a lot of her 'issues' (difficulty transitioning, obsessive, argumentative, intense, hard time making friend, latching on to older kids/parents, etc..) where due to anxieties and prescribed Pexeva. he said sometime that's all it takes 6 months on the stuff and they are back to being 'normal' or if it doesnt' work it would indicate that she has other issues.

    i'm very against drugs, and feel that she should receive theropy before resorting to drugs.

    the main side effect is abouta 15-20% weight gain which i'm also not thrilled about, given that he said that would remein with her, and heck the medicine might not do us any good at all.

    input appreciated :).
  2. I believe it's another name for Paxil, which is one of the SSRI drugs. Never tried it on my cub. Only knew one adult who took it; wasn't the right choice for him. I hope they gave you a product insert about it. Maybe someone who's used it will be on soon. Good luck.
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    It's long acting Paxil (I've taken Paxil for umpteen years now). Although it has been highly effective for me, I would hesitate to give it to a very young child with the symptoms yours has. For one thing, I feel it's powerful. It really, really helps me, but it's not a mild medication. It can cause some people to go into mania, and your daughter is really young. If she has trouble with transitions and has anxiety, I'd get a second opinion before medicating her with anything. You may want to take her to a neuropsychologist as she has symptoms that can be something other than what he diagnosed and, at age five, it's hard for even the best doctor to pin the right diagnosis. on a child. A neuropsychologist can be found in childrens or university hospitals, they do a lot of testing, and are coming from a different angle than a psychiatrist. In the case of my son a very good psychiatarist was wrong (diagnosed him with ADHD first, then bipolar) and he didn't have either one, so he was on a variety of medications (12) before being removed from then, and he actually did better. He needed community and school interventions as he has high functioning autism (Pervasive Developmental Disorder (PDD)-not otherwise specified). My own opinion is to go slow with both medications and accepting a diagnosis. on very young kids, and always seek second or even third opinions. Although your child may have something else, difficulty transitioning and high anxiety can be due to Autism Spectrum Disorders (ASD). Any speech problems/delays? Social interaction issues? How does he do in crowds, with noise, with lights? Does her do give-and-take play with kids? Play appropriately with toys or does she, say, line up cars or just tend to examine toys and shake them? Any strange high pitch noises or hand flapping or repetitive behavior (rocking?) My son didn't really have the last symptom, but many Autism Spectrum Disorders (ASD) kids do and, yes, they do obsess. My son is 13 and WAY better, but he still has his obsessions. It's part of the Spectrum. So you may want to look there before medicating. I'd hate for you to go on the medications-go-round that we did! Although I do believe your doctor is good, I'm leery of trying medications first, then looking elsewhere. If it were me, and I had it to do over again, I'd look for every possible reason first, THEN do medications only if necessary. I suspect, although I'm not sure, that he may be thinking she could be mildly on the Spectrum, but he's giving medications before saying so, which, in my humble opinion, is backwards. But I'm just a Mom. At any rate, here's an online Pervasive Developmental Disorder (PDD) test you can take for your child. While it can't diagnose, people on the Pervasive Developmental Disorder (PDD) board I go to feel it is accurate, if you answer it honestly. For us, our psychiatrist didn't really know much about Autism Spectrum Disorders (ASD) so he missed it. It's a Neurological rather than Psychiatric disorder and the best outcome is in the interventions the child gets, not necessarily any medication.
    Good luck with hard choices!
  4. smallworld

    smallworld Moderator

    There are more side effects to Paxil than weight gain. My daughter (difficult child 2) was on Paxil for 3 months in the spring/summer of 2005. It was prescribed for anxiety and depression. It caused her to experience strange disinhibited and aggressive episodes. When these episodes occurred, her then psychiatrist (psychiatrist) just raised the Paxil dose. The episodes become stranger and more frequent. We finally took difficult child 2 to a new psychiatrist, who immediately recognized that the episodes were caused by Paxil and weaned her off of the medication. My daughter then suffered from 2 weeks of withdrawal illness (headache, nausea, diarrhea and dizziness). Believe me, it was one of the most unpleasant experiences my husband and I have lived through as parents, not to mention the trauma difficult child 2 experienced.

    I have since learned: 1) that child psychiatrists rarely, if ever, prescribe Paxil because it frequently causes disinhibition in children; and 2) because of the way it's metabolized, Paxil is one of the hardest antidepressants to wean from. Furthermore, the only SSRIs FDA-approved for children are Prozac, Zoloft and Luvox.

    Your daughter is young. I would go with your gut and consider therapeutic interventions before medications (and especially before resorting to Paxil). I also agree that she should have further testing by a neuropsychologist (found at children's and university hospitals) to make sure you know what childhood disorder you're dealing with. If the psychiatricist you saw is not a board-certified child psychiatrist (they are different from adult psychiatrists), I would strongly recommend a second opinion from one who has expereince and training with children.

    Good luck and welcome to the board.
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I'd get a 2nd opinion regardless. Psychiatrists, like all other doctors these days, are specialized and they know Psychiatry. Often they know next to nothing about Neurological disorders and often (again) neurological disorders mimic psychiatric disorders. Lots of Autism Spectrum Disorders (ASD) people are misdiagnosed with various psychiatric problems--it's really a mess. Our professionals truly are too specialized. That's why I'd see a neuropsychologist. They do actual testing and, while there are no blood tests, the results point to certain disorders. Psychiatrists tend to just listen to what the parents say and diagnose from there. I don't like the idea of a quick prescription of any medication, let alone Paxil. I'd say the same for Prozac, Zoloft or Luvox. Even if they are approved for kids, they also have the weaning off problem and are potent drugs and, if your kid has early onset bipolar or Autism Spectrum Disorders (ASD), they can still get manicky from those medications. None of them are mild drugs. See what is causing the obsessions and anxiety rather than trying to stop them, in my opinion--doctors to often do it the other way around (which is what happened to us) thus our huge medications fiasco. One medication leads to, "Well, this medication didn't work, but let's try another similar drug" until your kid has trialed every medication in the classification. Then they sometimes move onto a new class of drugs, again which happened to our son. And our son gained 40 pounds from the medications. I'm thin on Paxil, but I'm an adult and can control it (still, it made me very heavy at one time). I just wouldn't do it that way. Id see the neuropsychologist first.
  6. tiredmommy

    tiredmommy Site Moderator

    Hi and welcome Lcl,
    I have to agree with the others that a 2nd opinion may be in order. It's important to understand that the buck stops with you. You have concerns about the diagnosis and treatment plan, they are valid. Also, 45 minutes may not have been adequate to get a clear picture of your daughter's issues.
    [ QUOTE ]
    Although your child may have something else, difficulty transitioning and high anxiety can be due to Autism Spectrum Disorders (ASD). Any speech problems/delays? Social interaction issues? How does he do in crowds, with noise, with lights? Does her do give-and-take play with kids? Play appropriately with toys or does she, say, line up cars or just tend to examine toys and shake them? Any strange high pitch noises or hand flapping or repetitive behavior (rocking?)

    [/ QUOTE ]
    I'm interested in reading your answers to MWM's questions. Many symptoms overlap in the most common disorders we see here. We aren't doctors and can't diagnose your child. But we may be able to point you in the right direction. :laugh:
  7. lcl

    lcl New Member

    See that’s the thing, I’m very anti-drugs (I know that sounds goofy) especially in someone so young. My nephew went down that path and is now so medicated, it breaks my hart.

    Midwest mom- nope actually very advance in speech, yes some social interaction issues (she usually clings/befriends the older children/teacher etc.. and doesn’t’ really care for her pears though ones sonone seeks HER out as a friend she’s a pretty good one), no problems with corws or noise, does like any 4-5 year old would with give and take play -actually plays really well with her 2 year old sister. But at the same time had HER trained before she turned one not to even touch certain dolls. She does arrange dolls/animals in a certain way and freaks if someone messes them up, but does play with them not jus ‘examine’ or shake. Sometimes she talks/acts babish making her voice young for her age (though the actual words she uses are more at an 8 yr. level) but that’s proably because of her sister. No repetitive behavior. Thank you so much for your input, will take the test!

    Smallworld- I’m so sorry you and your daughter had to go through all that! Thanks for your advice.

    Also what kind of testing would a neurophysiologist do?

    I might be wrong but I think this dr. said he used to do neurology… he did check muscle tone, in her eyes, and other things that surprised me that he did.. But than again I have 0 experience with any of this!!

    Tiredmommy- thank you, I so appreciate all the feed back.

    The psy. We went to see actually has not taken any new patients in 5 yrs. He’s supposedly the best in this city, and one my pediatrician. Said she would love for her to go see (just she didn’t think she could get her in) but my mom knows him from church and that’s how we got her in.

    I have a well baby visit for my easy child (ha! Learning the ling here J) and I will ask my pediatrician what she thinks Thursday. But as of now I think I will call him (I was going to just wait till our follow up in 2 weeks but husband said that I should call because the follow up is really to see how she’s doing on the drugs, and that will not apply) and tell him that I talked and prayed with my husband about it and decided that we can not at this time agree to medicating her without trying theropy first. If he could provide us with a theropy plan (I know he does counseling etc..) and hold off on the drugs that would be great.

    I mean we’ve waited THIS long, why not give theropy a real try!!!

    Thanks so much for all the input, please keep it coming J
  8. SRL

    SRL Active Member

    Paxil is a medication rarely recommended for young children due to some possible serious side effects so I'm surprised at seeing it recommended for one so young.

    I wouldn't just get a second opinion before medicating her--I would get a full multidisciplinary evaluation done. We did resort to medications for my son's acute anxiety and due to some serious side effects decided that a full out assault of other methods was what was best for him and our family. My son is doing beautifully now but I cannot stress enough the importance of having accurate complete and accurate assessment data on him.

    I have a son who approaches the high end of the Autistic Spectrum and also think that it would be well for you to look more closely into this. The average age for an Autism Spectrum Disorders (ASD) diagnosis in the US is 6 so it frequently gets overlooked and misdiagnosed by professionals. Parents whose children display even some of the symptoms need to be very vigilant because the atypical children are hardest to diagnose. Here's a link to the highest functioning Autism Spectrum Disorders (ASD) which is Asperger's Syndrome.

  9. lcl

    lcl New Member

    SRL- how would I go about getting a "I would get a full multidisciplinary evaluation done"? I am somewhat familiar with Asperger's ... i just don't see it being what lessi has. maybe very few of the characteristics, but most not....

    thanks for the input :)
  10. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    You can get a MDE at a Children's or University Hospital. Since your child does have some Autism Spectrum Disorders (ASD) symptoms (not interested in peers/plays with older kids/organizes toys) it can't hurt to evaluate, although she is pretty young to get the diagnosis. even if she has it. Aspergers kids talk on time, often in a precocious way. Not saying she has it, but there are some red flags. No Autism Spectrum Disorders (ASD) kid has all the symptoms, but early intervention with this is so important that I'd still see a NeuroPscyh over a MDE (one professional who will do tons of testing). If indeed she is even slightly on the Spectrum interventions can make all the difference in her prognosis as an adult. My son didn't get his diagnosis. until age elevin--he was "atypial" Pervasive Developmental Disorder (PDD) or Pervasive Developmental Disorder (PDD)-not otherwise specified. He first had a diagnosis. of ADHD/ODD, then bipolar, both WRONG. In all, he was on twelve different medications that he didn't need. Autism Spectrum Disorders (ASD) doesn't require medication, just good interventions, but there MUST be interventions or the child misses out, and the earlier the better. Good luck, whatever you decide.
  11. SRL

    SRL Active Member

    lcl, the blurb below was written about getting a MDE for Autistic Spectrum Disorders but all the information is applicable in general. I'll put it in a seperate post or two since it's so long.

    Just a word of caution: Even if one is somewhat familiar with Asperger's might not mean something along those lines would be easily recognizable in one's own child. I cannot tell you how many parents I've known who have had one child on the spectrum and then when another of their children starting showing signs it wasn't easy to recognize because often Autism Spectrum Disorders (ASD) children present differently. None of us here are diagnosticians but the symptoms you have given us (anxiety, doesn't care for peers, obsessive, difficulty transitioning, argumentative, intensive, hard time making friends, prefers adults/older kids, very advanced in speech, arranging toys) waves red flags to us because ALL of those symptoms are common in the Autistic Spectrum Disorders. Autism is a spectrum so it's fairly typical to see children who deviate from the clinical criteria in one or more ways. For instance, my son was far more interactive with people as well as being far more verbal so when I was first considering answers I never would have looked towards Autism. It was only after getting to the other side of the diagnostic fence that I was able to see the other traits as what they really were.

    Again, none of us here know exactly what you are dealing with but we're a little suspect that you don't have the full story yet.
  12. SRL

    SRL Active Member

    Here's some details about evaluations:
    It would be best for most parents who come this far looking for answers to consider pursuing a private multidisciplinary evaluation if they have the financial means to do so and/or insurance coverage for developmental issues. Evaluations through public sources (ie state, regional, county, local public school districts) can yield accurate and valuable data but often do not have the medical aspect represented. If you can afford a private evaluation, it is advisable to go that route and use the public resources as supplemental.

    A private multidisciplinary evaluation will vary depending on what’s available in your region but often here in the US will be done on an outpatient basis at a Children’s Hospital, University hospital, or Autism Clinic. Because a referral is usually needed at these facilities, the quickest route is to make an appointment with your pediatrician to discuss your concerns and request an referral. In other countries that first step might mean contacting a regional developmental center or a visiting health nurse.

    Bring along copies of any paperwork you have filled out as well as a list of all behavioral concerns you have.

    Some physicians will be reluctant to give you a referral, especially if they haven’t personally observed speech and social delays (which is unlikely in an office setting unless those are fairly pronounced). Be insistent that you want a multidisciplinary evaluation and if the doctor doesn’t listen, find one who will.

    First time appointments for most evaluations are running at least 3-6 months out and some parents are reporting waiting lists of up to one year to see medical professionals so it’s wise to get an appointment on the books and do your research while you’re waiting! If your appointment is more than 3 months out you should request to be placed on a cancellation list. If you do this, inform them that you are very flexible and then be prepared to move on short notice.

    While waiting for an appointment it’s totally normal for your thoughts to vacillate between considering something might be amiss with your child and believing that he/she is “normal”. The rule of thumb is that if you’ve come this far looking for answers and/or if the child’s mother suspects something might not be right, it’s a good idea to pursue an evaluation. Early intervention can be critical for some Autism Spectrum Disorders (ASD) kids so it’s far better to have an evaluation done and find out you’re on the wrong track than to skip an evaluation and miss out on important early intervention years. Also worth mentioning is that most parents have a very hard time even considering Autism. Those reasons are varied, but frankly many of us struggle with even the very suggestion that our child might have some form of Autism. If you’ve come this far and are still unsure, that’s common at this stage. Autistic Spectrum Disorders are tricky to diagnose and many children are not identified in their early years, which is why a professional opinion is invaluable.

    We understand that making the decision to seek out an evaluation is a scary prospect for most parents. It is important to realize at the onset that an evaluation does not automatically mean that your child will be labeled for life, that your child will spend their school years in special education classrooms, that a doctor is going to insist that you medicate your child, or that you are going to be blamed for your child’s problems (all are common concerns of parents considering evaluations). What it does mean is that at the end of the evaluation process you should have a much better grasp of your child’s strengths and weaknesses and you will be far better equipped to make important decisions that will impact their future. No matter what a professional says about your child or recommends for them, you are the parent and your child is your responsibility. Ultimately all choices regarding how to approach treatments and schooling rest with you and we parents have many success stories even though we hold to widely ranging philosophies, have utilized different treatment options, and have tapped into varying schooling arrangements.
  13. SRL

    SRL Active Member

    Second part on evaluations)

    The Evaluation Process

    Evaluations are organized differently in that some facilities utilize a team approach with professionals from various specialties all meeting together with the parents and child for the initial interview and then again to discuss their findings and recommendations. Others will operate by having the child seen by one primary specialist (usually a medical doctor) who makes referrals to other professionals and then takes their findings into consideration when making a final diagnosis. Either arrangement is fine and it is likely that you won’t have a choice. Also, be prepared to travel up to a few hours drive away unless you live in community with a large medical facility.

    In general you want to make sure that all of the following basic areas are covered: assessments for Autistic Spectrum Disorders, speech-language, hearing, and occupational therapy for motor skill and sensory issues.

    Assessment for Autistic Spectrum Disorders:
    You will want to have your child evaluated for Autism by a professional who has experience in pediatric Autism assessment. Which type of professional may depend upon what’s available in your region and upon your financial resources or medical plan.

    The most common options (using US terminology) would include:
    1)Developmental & Behavioral Pediatrician—a developmental pediatrician trains first as a regular pediatrician and then goes on for advanced work in pediatric developmental issues. Many parents find this route to be a good choice because a) they are likely to get accurate diagnoses, b) they’re usually good about referring on to other specialists as needed, c) a medical opinion can carry considerable weight with school districts that are reluctant to provide services, and d) it establishes an ongoing relationship with a medical doctor should medications become necessary.

    2)Pediatric Neuropsychologist—A neuropsychologist is a psychologist that has advanced training in assessing neurological/mental health issues. Referrals to neuropsychologists for diagnosing and ruling out Autism are becoming more common because of the acute shortage of developmental pediatricians in the US. Most parents are reporting that they are getting accurate diagnoses and sufficient leverage for needed services from this specialty area. Neuropsychs tend to delve more deeply into diagnostics and seek not only identify the primary underlying cause but also to surface more about the child’s specific strengths and weaknesses. Typically they are involved with the child during the assessment phase only and cannot prescribe prescription medications because they are not medical doctors. If you are being referred to a psychologist for an evaluation, be sure that it’s specifically a neuropsychologist and not a regular child psychologist unless they specialize in Autistic Spectrum Disorders (such as might be found on staff at an Autism Clinic).

    3)Pediatric Neurologist—Pediatric neurology is a third option for Autism Spectrum Disorders (ASD) assessment. This route may result in an accurate diagnoses but it should be noted that if the child is atypical (ie on the fence criteria-wise or more social/verbal than what might be expected of Autism Spectrum Disorders (ASD) kids) one of the above options would be preferable.

    There are two important things to remember when seeking out a diagnosis. The first is that there is a difference between recognizing Autistic Spectrum Disorders and being qualified to diagnose Autistic Spectrum Disorders. Other parents, teachers, therapists, and school psychologists may indeed recognize an Autism Spectrum Disorders (ASD) child but only certain professionals have the qualifications to diagnose your child. The second thing to remember is that not all diagnosticians are created equal and there are those that are more experienced and skilled at diagnosing and ruling out ASDs. Don’t be afraid to
    ask about a professional’s qualifications before you schedule an appointment, both through inquiring at their office and through parents of special needs kids in your area.

    What to expect: Anticipate filling out a lot of paperwork in advance including family, medical, and developmental history. Make copies of all paperwork before sending it in because it will save you time later. Plan on first time appointments being around
    1-2 hours in length and to include some observation of the child but to consist mostly of parent interview. Testing (such as IQ) may be scheduled for a later appointment. A final diagnosis is usually given at a follow-up appointment and a report is sent to the parents including a summary of the child’s history, diagnosis, and recommendations for services.

    Speech-Language Assessment
    What to expect: Speech-language testing varies widely based on many factors (including age of the child and extent of the problems) but typically would consist of providing written developmental history in advance, 1-2 diagnostic appointments in a clinical setting, plus a follow-up appointment to discuss any diagnosis and recommendations.

    Hearing Examination
    All children who have speech-language issues should have a basic hearing test performed by a certified audiologist. If your child is age five or older plus reading well, at the conclusion of that appointment ask the audiologist if your child is ready to be scheduled for an evaluation for auditory processing problems. Typically this is not done until age 7, but exceptions can be made for younger exceptional readers who can follow verbal or written instructions well.

    What to expect: A short appointment in which the audiologist will do a few diagnostic tests to check the child’s ability to recognize sound input.

    Occupational Therapy Evaluation
    Many Autism Spectrum Disorders (ASD) children have challenges with motor skills and in handling normal sensory input (http://www.tsbvi.edu/seehear/fall97/sensory.htm). For this reason it is recommended that a private occupational therapy (Occupational Therapist (OT)) evaluation also be included as part of the initial round of evaluations. An Occupational Therapist (OT) evaluation isn’t always included unless problems are very pronounced and because many parents on our forum have regretted that later on, we highly recommend it be done while the child is still young and most likely to benefit from therapy. It’s important to be aware of the fact that in the US, public schools are only required to assess and treat occupational therapy issues that impact the child in the educational setting so a private evaluation is a good option if you have the resources.

    What to expect: An occupational therapy evaluation will vary depending on the age of the child and extent of their challenges. Expect to provide a developmental history in advance and for the child to take part in 1-3 hours of assessment in a clinical setting during which time the occupational therapist will interview the parent. A follow-up appointment is typically scheduled to discuss the results of the evaluation and to go over treatment recommendations, if indicated.
  14. lcl

    lcl New Member

    thank you so much for all the info! we decided not to do the Pexiva, and got a referal to a 'licensed professional counselor' and a 'psychiatric social worker" from her Psychologist. so what's the difference? - will ask on antoher thread also!

    thanks again! I am looking into all the suggestions you all gave me!!!!