It's hard to say out loud that I give medication to my young child.
It's hard to say it out loud because I imagine that I'm often saying it to people who regard medicating young children as a cop-out, an attempt at a quick-fix, and the result of an unwillingness to do the hard work of actual parenting. In other words, people who think the same way I used to think about the issue.
When Bud was three-years-old, I brought him for his annual visit with the developmental pediatrician who initially diagnosed his autism, the director of a child development clinic at a nationally-recognized teaching hospital. In our debrief meeting at the end of the hours-long visit, Dr. K explained that he is extremely conservative about recommending medication for young children, and that he always errs on the side of withholding it. That being said, though, he recommended that I meet with a child psychiatrist who specializes in autism to discuss the possibility of using an anxiety medication with Bud.
I was reluctant to follow his advice, so I spoke privately with the Speech and Language Pathologist who had been involved in the meeting, and who worked very closely with Dr. K. She said that he was not exaggerating when he said that he was extremely conservative, and that she'd rarely heard him recommend medication in a child so young. I agreed to meet with the psychiatrist, but when I called his office I learned that I'd need to wait at least a year for an appointment. I contacted Dr. K to let him know, and he had us booked for an appointment the following week.
The appointment with the psychiatrist was helpful. He was willing to write a prescription for Bud, but also said that he didn't think we'd be taking a significant risk by taking a "wait and see" approach. We decided to hold off on medication and we booked another appointment in a year's time.
We had a similar meeting when Bud was four, and once again we decided to wait. Then, the summer before Bud turned six and just before he started Kindergarten, we took him to a child psychologist for testing and decided that the time was right for something. Instead of focusing on Bud's anxiety, we focused on his attention and distractibility and we ultimately landed on Strattera, which has helped significantly with his focus and his ability to engage with people and tasks.
Then, this fall, Bud's anxiety level reached an all-time high. His anxiety transformed him emotionally and physically - he worried incessantly; he perseverated about the weather; he was anxious about leaving the house; he grew pale and sallow; the circles under his eyes deepened into a bruisy purple; he didn't eat very much; his face became gaunt. In desperation, I called his pediatrician and told her we were ready to try a medication for anxiety with him.
She prescribed Zoloft - a half dose for the first week, then a full dose after that. Within days, Bud's disposition started to change. The color came back to his cheeks. His appetite returned. He started to think about things besides the condition of the sky and his calculations about the likelihood of a storm. He started to play again, and to rediscover the things that brought him joy. With each day that passed, he worried about the weather a little less. Then the worry subsided into simple conversation about the weather.
Remarkably, since he started taking Zoloft, Bud has started having more actual, engaged, back-and-forth conversation. He's using more language, more effectively. His grammatical structure has gotten more complex; he's even started correcting himself.
I was goofing with him the other day, and said, "Look! I'm a monkey!"
He laughed and said "No, you not..." but his sentence trailed of and he caught himself, thought for a minute, and said "No, you... isn't."
"I'm not?" I asked.
"No, you're not!" he laughed.
Conversations that used to end at Question-Answer now take several turns. I put Bud's sandwich down on the table yesterday and he asked, "Mama, can I have potato chips with it?"
"We don't have any potato chips, hon," I said dismissively, expecting that he'd either drop the request or shift it to pretzels.
"They taked them?" he asked, indignantly. (I'm not sure who "they" were...)
"No, nobody took them."
"I ate them all," he said, suggesting what seemed the only plausible conclusion.
"Yes, you did."
"That's okay. We can buy some more."
His experience-sharing language has also grown exponentially. When I ask about his favorite part of his school day, I no longer get the same one-word answer: "Recess." Now I hear about Writer's Workshop and counting in math and the painting he did in art.
The other day he named all of the children who go to "Word Study" (the special ed group) with him, and he taught my husband and me one of their exercises. He held up a word card, and we had to say "letter-word-sound" - "B. Bell. Ba. K. Kite. Ka." He corrected us gently when we mixed up the order, by stating it correctly and looking at us intently until we repeated him. When we got through the stack, he said "45 seconds! Great work! And you're doing very good sitting, Mama."
He's calmer. He's more engaged. He's more interested in other children. He's using lots and lots of spontaneous, conversational language. All since he started taking Zoloft.
Of course, for every positive thought I have about Zoloft, I have two nagging thoughts:
What are the long-term effects of a powerful medication on a developing little body? and, conversely,
What would his development be like now if I'd followed the doctor's suggestion and started him on anxiety medication four years ago?
I know that dwelling on the "what ifs" is rarely helpful or productive. I really do know that. But the fact remains: Zoloft has had a significant effect on reducing Bud's anxiety, but it's left me stranded with a whole lot of my own.