Sunday, November 19, 2006

Anxiety medication and medication anxiety

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.

Simple conversation.


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.


Kristina said...

Glad to hear how the Zoloft is helping Bud---Charlie has been taking this medication (at varying doses) for a while. Any side effects? We've thought about taking him off it more than a few times, but feel it is helping hiim, and so have not.

Bud is saying some great things!

JenF said...

Medication is a touchy subject... there are people on both extremes - and folks in the middle. When our psychologist suggested meds for Ky for his behavioural issues, my response was simple "I'm not ready yet". I've read enough about them to see that they do work. So I've come down from my 'it's the easy road' view, to an open mind. Mostly, I felt that we were only just putting a plan together and if we medicated him along with all of the other changes, how would we know which was working?

We may or may not have meds in our future... but you can't let that second thought take root for too long - you make the best decisions you can for Bud at the time you are making them. You were open to changing that decision, and have seen positive results (I'd say super positive!)

I occassionally wonder if I had asked the right questions when Kyle was evaluated at 3.5 - would we have had a diagnosis, then progress, that much earlier? It took another 2 years to get to his sensory issues and ultimately Asperger's... but I can't focus on it, because it's done.

Glad to hear Bud is doing so well! I'm hoping to see more studies of how these meds affect developing brains and bodies... as I'm sure you do.

Daisy said...

We, too, opted for anti-anxiety meds for Amigo. These have the side-effect of reducing his tics as well, so it's a win-win. how long will he take this? We don't know. When he stops, we'll monitor very, very carefully.

mcewen said...

We're still dithering over medication. [scared] I hear it's such a roller coaster of 'a little bit more' or a 'little bit less' and then they go and grow.....
Best wishes

Shawn said...

It's great that the results of the Zoloft were so clear for Bud. I find that determining efficacy can be very difficult. When the changes are more subtle it's hard to identify the cause of the changes. Was it meds, or one of the many environmental tweaks we've made to reduce anxiety?

I hope you don't fret too much. It sounds like you've found something that has made a big positive difference. Remember to celebrate the success!

Liesel Elliott said...

It is really great to hear about Bud's success with the medication. I have been worried that one of our experts would sugest such a thing for Daniel, and I didn't think I wanted to go in that direction. But seeing your child without the mask of anxiety that they wear must be a wonderful thing.

So far the weekly psychologist visits are helping Daniel alot. But your post really put my mind at ease. If medication is recommended, at least I know that it can provide a respite from the constant worrying that Daniel struggles with.


R said...

I'm so glad to hear that the medication is helping Bud.

neil said...

Medication, that's a tough one. One of our friend's son was suspended from our autistic school and they were virtually forced to put their son on it even though they didn't want to. One of M's friends that sleeps over is on some and I even suspect this child's mum is on it too - but who could blame her with two diagnosed children and a third pending. I know we are lucky when I had to look up what perserveration is. Long term vs short term, that's like being caught between a rock and a hard place, but I think sometimes we have to let the future take care of itself.

VTBudFan said...

Hmm, it seems to me that automatically dismissing people who choose medication as one of their tools as copping out is...well, a cop-out! That is so much easier than actually considering all the complex issues surrounding medication.

I had my eyes opened about this issue when I worked at a group home. I met a woman who, off meds, was virtually unable to function at all in the world. I met the same woman when she was on meds and literally did not recognize her. She was competent and assertive and part of the world. I have never since been able to assume that I know best about whether or not someone should be medicated.

Good for you for navigating those murky waters with your usual style of complete love and empathy for Bud, combined with lots of research. I'm so glad you are finding helpful resources for him.

MothersVox said...

Fantastic to hear that Zoloft is helpful for Bud. We didn't start Sweet M on medication until she had just turned five, but wow, did it make a difference.

All of her compulsive behavior vanished within a week of finding the right med. (She took Zoloft first and it wasn't right for her as it made her agitated and sort of mechanical. Then we switched to Paxil.)

She started on Paxil at the beginning of December 2002. Then the student speech clinicians she worked with took their winter break. When they came back from vacation, the director of clinic called to ask what we'd done to her. Apparently Sweet M had achieved all of her Spring semester speech goals over the holiday break -- without speech therapy -- so powerful and effective was this SSRI for her.

So I say three cheers for recognizing and treating the excessive anxiety that some of our children suffer with.

Wendy said...

Did Bud primarily script and echo before you started him on the SSRI's? And then he started more spontaneous speech after he'd been on it for awhile?

I want more than anything in the world for C to talk more. He has some language but not a lot at all. He still mostly says, "I want _______". Nothing has seemed to help over the years either - cod liver oil, DMG, auditory therapy, Super NuThera, L-Carnosine (we've stopped everything except the L-Carnosine).

Christine said...

Thanks so much for writing about this. When Oliver was first diagnosed I thought that I would never consider medication. Then we went through a period of three weeks when he practically didn't sleep at all -- even with melatonin AND Benedryl. So I decided to try him on Prozac. I guess I was against it because I thought it would change his personality or something. But it just helped us to see MORE of who he is, I think. Anyway, I appreciate your willingness to share this about Bud because it IS such a hard thing to talk about.

mom-nos said...

Wendy, he wasn't exclusively scripting before. We did see spontaneous language - just not as much of it, and especially not in a sustained conversational way. He is also using more language with the purpose of engaging with people, making observations, sharing his experience, problem-solving, offering alternatives and other ways of thinking about a situation, etc., as opposed to just (as you said) making requests. (In the parlance of RDI, it's the difference between "declarative" language and "imperative" language.)

Cindy Ericsson said...

The decision to medicate my son was not made easily, either, because I felt that should be a sort of last resort. Josh has tried a variety of medications since we started treating his autism and ADD symptoms. We have only seen positive effects from the Zoloft. Josh manages his emotions so much better now, and has even started eating cheeseburgers! (We have a lot of food issues...)

Our doctor told me that psychiatrists really like to push the dosage on meds to find the best dose (and realize the most benefit) for each child. He was very eager and excited as he said this; I found it very disturbing.

kyra said...

oh, mom-nos! so great to hear how the zoloft is helping bud! those conversations are wonderful to read about. they must be even more wonderful to experience.

snchocolate said...

I'm so glad to hear that I'm not the only one struggling with the med. things. They pushing to but my son on meds. We tried some and they made him so stoned I threw them away. And I'm hesitant to try anything else. Does anyone know about the natural stuff does it work on young kids with Autism. A mom in disstress!

MOM-NOS said...

Closing comments on this post because it's being spammed with medication ads. My apologies.