Recent reports that children under the age of 3 have received stimulant medication for ADHD has understandably led to an outcry about the potential harm to the developing brains of those children. More strident voices have used the finding to take up arms against the use of stimulant use for any child and even the more radical belief that any psychiatric medication use with children and adolescents is inherently evil.
The practice of medicine starts with disease and suffering of patients and families seeking help. The scientific findings of medicine and psychiatry provide an ever expanding knowledge database that must be artfully applied to each individual patient. The individual is not to be treated as a statistic nor part of a cohort. The individual has the right and the physician has the responsibility to develop a specific illness narrative that defines the nature of the illness or disability within a developmental framework that is respectful to biologic, familial, and sociocultural realities. Working with patients and families who struggle day to day and week to week to get by means that as a physician I need to cultivate awareness of the implications of each person’s vulnerability within the context he or she lives. Families with marginal resources, in communities lacking supports and services create physician / patient dynamics that push the limits of medical knowledge for the sake of trying something to offer hope in the face of despair.
I do not defend the widespread use of stimulant medication for children of any age and I am particularly concerned about the use of such medications in children under the age of 5. In my 30 years of practice I have initiated stimulant use for a handful of children less than age 5, and never for a child less than 4. However, the careful use of psychiatric medications with children and adolescents has brought relief and joy to many of the patients and families I have had the privilege of treating. I have witnessed the over and under use of medications with children and adolescents and I have worked with parents who have been against the use of medications and others who have come in wanting their child on a specific medication. It is my responsibility to sort through the layers of opinions and try to cultivate a respectful collaboration so that parents and youth can participate meaningfully in treatment decisions. I worry less about the statistics of medication over or under use and more about the loss of the professional intimacy between healthcare providers and those they try and serve. When any treatment is done to someone and not with someone, physicians and all healthcare professionals lose the bedrock of their noble profession. It is time for all of us to avoid our strident political agendas and remain committed to the right of each person seeking health care to receive treatment that is grounded in the authentic caring of a professional trying to do his or her best to reduce disease and suffering.
I do not defend the widespread use of stimulant medication for children of any age and I am particularly concerned about the use of such medications in children under the age of 5. In my 30 years of practice I have initiated stimulant use for a handful of children less than age 5, and never for a child less than 4. However, the careful use of psychiatric medications with children and adolescents has brought relief and joy to many of the patients and families I have had the privilege of treating. I have witnessed the over and under use of medications with children and adolescents and I have worked with parents who have been against the use of medications and others who have come in wanting their child on a specific medication. It is my responsibility to sort through the layers of opinions and try to cultivate a respectful collaboration so that parents and youth can participate meaningfully in treatment decisions. I worry less about the statistics of medication over or under use and more about the loss of the professional intimacy between healthcare providers and those they try and serve. When any treatment is done to someone and not with someone, physicians and all healthcare professionals lose the bedrock of their noble profession. It is time for all of us to avoid our strident political agendas and remain committed to the right of each person seeking health care to receive treatment that is grounded in the authentic caring of a professional trying to do his or her best to reduce disease and suffering.
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