Welcome to Childhood Made Crazy, an interview series that takes a critical look at the current “mental disorders of childhood” model. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions in the mental health field. To learn more about the series, to see which interviews are coming, and to learn about the topics under discussion, click here.
Steevie Parks started working in the field of mental health in 1975. Before going back to school to pursue a Ph.D. in Clinical Psychology, she worked as both a Special Education Teacher and a Rehabilitation Therapist for the State of New York. Immediately after attaining her Ph.D. in Clinical Psychology in 1988, she entered private practice as a Clinical Psychologist. Since then, Dr. Parks has worked in numerous in-patient and out-patient settings in addition to maintaining a private practice in Clinical Psychology since 1988.
EM: How would you suggest a parent think about being told that his or her child meets the criteria for a mental disorder or a mental illness diagnosis?
SP: I would ask that a parent first recognize that a diagnosis is nothing more or less than a professional 'opinion'. It is not a fact. Many parents take professional opinions as if they were universal truths. If a diagnosis frightens or upsets you, it is advisable to do some reading about it on your own or to at least ask the professional to recommend some literature to help you to come to terms with what you might be dealing with.
In general, if a trusted mental health professional is able to back up their diagnosis with evidence (data) that makes sense and prescribes treatment methods that seem to make good sense and not raise alarm bells, it is generally worthwhile to give them a try. Remember, you can always get a second opinion, and research different options than those that the doctor has provided.
EM: How would you suggest a parent think about being told that his or her child ought to go on one or more than one psychiatric medication for his or her diagnosed mental disorder or mental illness?
SP: It is always a good idea to ask questions and to do your own research before blindly agreeing to put your child on any type of psychiatric medication. Once you decide to allow your child to try a particular medication, it is important to look out for any possible side effects or complications. A psychiatrist will need to do a thorough evaluation of your child's medical status before prescribing any drugs. When this happens, don't leave any stone unturned. Tell them everything you know about allergies, sleep habits, etc. to help prevent problems that might arise. Psychiatric medications are powerful and their use requires careful monitoring by both parents and the physicians involved in their care.
EM: What if a parent currently has a child in treatment for a mental disorder? How should he or she monitor the treatment regimen and/or communicate with mental health professionals involved?
SP: One of the most important factors that parents need to understand is that 'Timing Matters'. Get specific instructions about when your child is supposed to take the medicine. Many of these medicines only work for a specific period of time. Towards the end of the cycle, a child will often experience some symptom breakthrough. So it's important to provide the next dose either before or close to the time that the last dose starts to wear off.
Parents need to watch for things like excessive fatigue, agitation, and or physical complaints for the first several weeks of starting a new medication and to mention this to your provider at the next visit. If you notice serious physical side effects such as difficulty breathing or seizures call your physicians emergency service right away. If you notice serious 'behavioral side effects' such as suicidal ideation (when a child starts to have thoughts about killing themselves), or significant increases in aggression, a parent should leave a detailed message with their physician and immediately schedule a visit with your child's therapist to better understand the symptoms and how to proceed.
It is normal for changes to occur and for medications needing to be changed from time to time due to unwanted side effects. The more carefully parents monitor their child's behavior and stick to the prescribed dosing regimen, the more likely it is that things will proceed smoothly and without negative consequences.
EM: What if a parent has a child who is taking psychiatric drugs and the child appears to be having adverse effects to those drugs or whose situation appears to worsening? What would you suggest the parent do?
SP: It is very important to notify the prescribing physician at once when severe behavioral symptoms worsen while a child is taking antipsychotic medication. Physicians need to be immediately responsive to these situations because some medications can cause more serious symptoms than they were meant to treat. This most often occurs when a child was incorrectly diagnosed.
Thirty years or so ago, it was common for a child to undergo an extensive battery of psychological tests before being given a serious psychiatric diagnosis. This way there was a lot more reassurance that the diagnosis was accurate. Nowadays, psychiatrists rarely even ask a psychologist for their opinion, let alone refer a child for testing before prescribing potentially dangerous drugs. Part of this is due to the fact that insurance companies put pressure on doctors to form a diagnosis within the first session. As a result, many faulty diagnoses are made and this creates room for trouble.
SP: All children (and all adults) experience emotional difficulties from time to time. The best way for a parent to help a child who is struggling with difficult feelings is to make some regular time to give your child your undivided attention. Children communicate in different ways. If your child is old enough to have a conversation about their feelings, this generally will help.
You will need to ask open-ended questions to get your child to open up. Try to spend more time listening and reflecting rather than giving advice. Often children just need to know that you are emotionally present and supportive. Children, like adults, feel emotionally empowered when their feelings are respected and validated. It is also helpful to make sure that your child has plenty of good creative and physical outlets to help them to learn to successfully regulate their emotions and behavior. Children (like their adult counterparts) need to be actively involved and engaged in stimulating social, intellectual and physical activities in order to be psychologically healthy.
EM: What would you like to say to a parent whose child is in difficulty and who would like to put her trust in the current mental health system?
SP: I would tell that parent not to be afraid to talk to other parents in order to find an ethical and compassionate provider who takes the right kind of time to get a thorough picture of what 's going on before pushing any particular treatment regimen. There are a lot of 'quick and dirty' practitioners out there who were trained to convince parents that they know all of the answers before they have fully analyzed the situation. It is my opinion (after working as a child psychologist for over 30 years), that both psychology and psychiatry in the U.S. have gradually become too 'business oriented', and less and less 'professionally oriented'. You should make sure that you are working with a conscientious professional who is not afraid to answer tough questions and who shows genuine compassion for not only your child but for you as caretakers of that child.
EM: As a parent yourself of a child who received a mental disorder diagnosis, what do you wish you had known at the beginning of that process that you know now?
SP: Good question. If I had to do it all over again, I would have trusted my own instincts even more than I did and may have chosen to take my child out of public school at an earlier age vs. pumping him up with medication so that he could succeed in an environment that was too stimulating for him to manage on his own.
I would have pushed harder to find a special school. Part of this was my fault because I was in denial about how serious my son's issues were. Because he has always been extremely intelligent, I pushed him hard to do well in school. I felt threatened when my son's principal recommended that he go into a special contained classroom for children with Autism. I decided to keep him mainstreamed, but with each year it took more and more medication to keep him there.
When my son graduated from middle school with straight A's (but no friends), I sent him to a small charter school. He felt much more comfortable there and was treated much better by his peers. So what I learned was that it's ok to set up an easier environment for a child with special needs. Sometimes you can do more harm than good by pushing a child with serious problems to fit in to a regular environment by adding drugs. There's more to life than doing well in school. Most psychiatric drugs/medications are designed to help people to function in normal environments. Yet if the side effects are damaging, perhaps the environments are better modified.