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Does anyone have any experience with the meds and the behavior...

Parents Support One Another @ = I need help with the following issue:

Hello all- i am at the end of my rope. i have watched my son become more and more rebellious, and dangerous to himself. he does not respect anyone except his step father. he is really horrible to his grandmother. ok- he is on abilify, they just upped the dose to 7.5 mg. he takes clonidin to help him sleep at night. in the morning he takes metadate cd. for a year, this was working perfectly. his grades came up and he finally passed kindergarten. this school year it is all falling apart..... he sees no problem with slamming the door in his grammas face and telling her he IS going out. no matter what. no one knows where he is for hours.... he is often seen riding his bike (when he had it) on a very busy street. after a call to the doc this morning, it was suggested to me that the only alternative left is a residential care facility. he said after 4 or 5 months the children come out knowing how to cope with authority, rules, and temper.

my son is only 7. it breaks my heart to do this to him. does anyone have any experience with the meds and the behavior... or the away from home therpay. i am losing it here....



How Medications (Meds) Are Used—

Medication can be an effective part of the treatment for several psychiatric disorders of childhood and adolescence. A doctor's recommendation to use medication often raises many concerns and questions in both the moms & dads and the youngster. The physician who recommends medication should be experienced in treating psychiatric illnesses in kids and teens. He or she should fully explain the reasons for medication use, what benefits the medication should provide, as well as possible risks and side effects and other treatment alternatives.

Psychiatric medication should not be used alone. The use of medication should be based on a comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.

Before recommending any medication, the psychiatrist interviews the youngster and makes a thorough diagnostic evaluation. In some cases, the evaluation may include a physical exam, psychological testing, laboratory tests, other medical tests such as an electrocardiogram (EKG) or electroencephalogram (EEG), and consultation with other medical specialists.

Meds which have beneficial effects may also have side effects, ranging from just annoying to very serious. As each youngster is different and may have individual reactions to medication, close contact with the treating physician is recommended. Do not stop or change a medication without speaking to the doctor. Psychiatric medication should be used as part of a comprehensive plan of treatment, with ongoing medical assessment and, in most cases, individual and/or family psychotherapy. When prescribed appropriately by a psychiatrist (preferably a psychiatrist), and taken as prescribed, medication may reduce or eliminate troubling symptoms and improve the daily functioning of kids and teens with psychiatric disorders.

Medication may be prescribed for psychiatric symptoms and disorders, including, but not limited to:

1. Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or posttraumatic stress disorders)-if it keeps the youngster from normal daily activities.
2. Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble concentrating and restlessness. The youngster is easily upset and frustrated, often has problems getting along with family and friends, and usually has trouble in school.
3. Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)-characterized by severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed in early childhood.
4. Bedwetting-if it persists regularly after age 5 and causes serious problems in low self-esteem and social interaction.
5. Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods, which may include irritability, "high" or happy mood, excessive energy, behavior problems, staying up late at night, and grand plans.
6. Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness and guilt, inability to feel pleasure, a decline in school work and changes in sleeping and eating habits.
7. Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting (bulimia), or a combination of the two.
8. Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive thoughts) and/or compulsions (repetitive behaviors or rituals such as handwashing, counting, checking to see if doors are locked) which are often seen as senseless but which interfere with a youngster's daily functioning.
9. Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing sounds that don't exist) social withdrawal, clinging, strange behavior, extreme stubbornness, persistent rituals, and deterioration of personal habits. May be seen in developmental disorders, severe depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse.
10. Severe aggression-which may include assaultiveness, excessive property damage, or prolonged self-abuse, such as head-banging or cutting.
11. Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of separation, anxiety.

Types Of Meds—

Psychiatric meds can be an effective part of the treatment for psychiatric disorders of childhood and adolescence. In recent years there have been an increasing number of new and different psychiatric meds used with kids and teens. Research studies are underway to establish more clearly which meds are most helpful for specific disorders and presenting problems. Clinical practice and experience, as well as research studies, help physicians determine which meds are most effective for a particular youngster. Before recommending any medication, the psychiatrist (preferably a psychiatrist) should conduct a comprehensive diagnostic evaluation of the youngster or teen. Moms & dads should be informed about known risks and/or FDA warnings before a youngster starts any psychiatric medication. When prescribed appropriately by an experienced psychiatrist (preferably a psychiatrist) and taken as directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of kids and teens with psychiatric disorders.

ADHD Meds: Stimulant and non-stimulant meds may be helpful as part of the treatment for attention deficit hyperactive disorder (ADHD). Examples of stimulants include: Dextroamphetamine (Dexedrine, Adderal) and Methylphenidate (Ritalin, Metadate, Concerta). Non-stimulant meds include Atomoxetine (Strattera).

Antidepressant Meds: Antidepressant meds may be helpful in the treatment of depression, school phobias, panic attacks, and other anxiety disorders, bedwetting, eating disorders, obsessive-compulsive disorder, personality disorders, posttraumatic stress disorder, and attention deficit hyperactive disorder. There are several types of antidepressant meds. Examples of serotonin reuptake inhibitors (SRI's) include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), Venlafaxine (Effexor), Citalopram (Celexa) and Escitalopram (Lexapro). Examples of atypical antidepressants include: Bupropion (Wellbutrin), Nefazodone (Serzone), Trazodone (Desyrel), and Mirtazapine (Remeron). Examples of tricyclic antidepressants (TCA's) include: Amitriptyline (Elavil), Clomipramine (Anafranil), Imipramine (Tofranil), and Nortriptyline (Pamelor). Examples of monoamine oxidase inhibitors (MAOI's) include: Phenelzine (Nardil), and Tranylcypromine (Parnate).

Antipsychotic Meds: These meds can be helpful in controlling psychotic symptoms (delusions, hallucinations) or disorganized thinking. These meds may also help muscle twitches ("tics") or verbal outbursts as seen in Tourette's Syndrome. They are occasionally used to treat severe anxiety and may help in reducing very aggressive behavior. Examples of first generation antipsychotic meds include: Chlorpromazine (Thorazine), Thioridazine (Mellaril), Fluphenazine (Prolixin), Trifluoperazine (Stelazine), Thiothixene (Navane), and Haloperidol (Haldol). Second generation antipsychotic meds (also known as atypical or novel) include: Clozapine (Clozaril), Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon) and Aripiprazole (Abilify).

Mood Stabilizers and Anticonvulsant Meds: These meds may be helpful in treating bipolar disorder, severe mood symptoms and mood swings (manic and depressive), aggressive behavior and impulse control disorders. Examples include: Lithium (lithium carbonate, Eskalith), Valproic Acid (Depakote, Depakene), Carbamazepine (Tegretol), Gabapentin (Neurontin), Lamotrigine (Lamictil), Topiramate (Topamax), and Oxcarbazepine (Trileptal).

Anti-anxiety Meds: These meds may be helpful in the treatment of severe anxiety. There are several types of anti-anxiety meds: benzodiazepines; antihistamines; and atypicals. Examples of benzodiazepines include: Alprazolam (Xanax), lorazepam (Ativan), Diazepam (Valium),and Clonazepam (Klonopin). Examples of antihistamines include: Diphenhydramine (Benadryl), and Hydroxizine (Vistaril). Examples of atypical anti-anxiety meds include: Buspirone (BuSpar), and Zolpidem (Ambien).

Sleep Meds: A variety of meds may be used for a short period to help with sleep problems. Examples include: Trazodone (Desyrel), Zolpidem (Ambien), Zaleplon (Sonata) and Diphenhydramine (Benadryl).

Miscellaneous Meds: Other meds are also being used to treat a variety of symptoms. For example: clonidine (Catapres) may be used to treat the severe impulsiveness in some kids with ADHD and guanfacine (Tenex) for "flashbacks" in kids with PTSD.

Long-Acting Meds: Many newer meds are taken once a day. These meds have the designation SR (sustained release), ER or XR (extended release), CR (controlled release) or LA (long-acting)

Questions To Ask—

Medication can be an important part of treatment for some psychiatric disorders in kids and teens. Psychiatric medication should only be used as one part of a comprehensive treatment plan. Ongoing evaluation and monitoring by a physician is essential. Moms & dads and guardians should be provided with complete information when psychiatric medication is recommended as part of their youngster's treatment plan. Kids and teens should be included in the discussion about meds, using words they understand. By asking the following questions, kids, teens, and their moms & dads will gain a better understanding of psychiatric meds:

1. Are there any activities that my youngster should avoid while taking the medication? Are any precautions recommended for other activities?
2. Are there any laboratory tests (e.g. heart tests, blood test, etc.) which need to be done before my youngster begins taking the medication? Will any tests need to be done while my youngster is taking the medication?
3. Are there any other meds or foods which my youngster should avoid while taking the medication?
4. Are there interactions between this medication and other meds (prescription and/or over-the-counter) my youngster is taking?
5. Does my youngster's school nurse need to be informed about this medication?
6. How long will my youngster need to take this medication? How will the decision be made to stop this medication?
7. How will the medication help my youngster? How long before I see improvement? When will it work?
8. Is this medication addictive? Can it be abused?
9. What are the side effects which commonly occur with this medication?
10. What do I do if a problem develops (e.g. if my youngster becomes ill, doses are missed, or side effects develop)?
11. What is known about its helpfulness with other kids who have a similar condition to my youngster?
12. What is the cost of the medication (generic vs. brand name)?
13. What is the name of the medication? Is it known by other names?
14. What is the recommended dosage? How often will the medication be taken?
15. Will a psychiatrist be monitoring my youngster's response to medication and make dosage changes if necessary? How often will progress be checked and by whom?

Treatment with psychiatric meds is a serious matter for moms & dads, kids and teens. Moms & dads should ask these questions before their youngster or teen starts taking psychiatric meds. Moms & dads and kids/teens need to be fully informed about meds. If, after asking these questions, moms & dads still have serious questions or doubts about medication treatment, they should feel free to ask for a second opinion by a psychiatrist.

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